MEDICARE: CRYSTAL D SLEDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1225817067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL D SLEDGE

Provider Business Mailing Address
First Line	:	451 E 272ND ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1724
Country	:	US
Telephone Number	:	216-240-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE STE 315
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3758
Country	:	US
Telephone Number	:	216-465-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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Directions to “ CRYSTAL D SLEDGE ” Practice Location

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