=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902850183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA H. IRELAND M.ED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 PEARL RD SUITE C-3 WEST
-----------------------------------------------------
City | STRONGSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44136-3349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-891-8848
-----------------------------------------------------
Fax | 330-940-9004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 CEDAR WOODS DR
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-1286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-891-8848
-----------------------------------------------------
Fax | 330-940-9003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2504
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------