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General NPI Number Information
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NPI Number | 1447363064
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Entity Type | Individual
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Provider Name | JESSICA BLYTHE HORVAT LISW
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 12417 CEDAR RD STE 21
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City | CLEVELAND HTS
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State | OH
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Zip | 44106-3157
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Country | US
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Telephone | 330-915-2907
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 CROYDEN RD
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City | LYNDHURST
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State | OH
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Zip | 44124-1417
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Country | US
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Telephone | 330-915-2907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10010148
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License Number State | OH
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