MEDICARE: JOANNA K CLINE PCC

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	101YP2500X	Professional Counselor	E.0501079	OH

General Provider Information

NPI Number	:	1235436056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA K CLINE PCC

Provider Business Mailing Address
First Line	:	3610 W MARKET ST STE 102
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-9301
Country	:	US
Telephone Number	:	330-808-1311
Fax Number	:	330-666-5001

Provider Business Practice Location Address
First Line	:	3610 W MARKET ST STE 102
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-9301
Country	:	US
Telephone Number	:	330-808-1311
Fax Number	:	330-666-5001

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	09/08/2011

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