=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962292219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERESA TSCHANNEN, PHD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5054 PARAMOUNT DR OFC 9
-----------------------------------------------------
City | MEDINA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44256-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-304-8290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5054 PARAMOUNT DR OFC 9
-----------------------------------------------------
City | MEDINA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44256-5363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-304-8290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. THERESA TSCHANNEN ISABELLA
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 330-421-7805
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------