MEDICARE: LUCKY JEAN HARRIS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1295558765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCKY JEAN HARRIS

Provider Business Mailing Address
First Line	:	2112 HAMPSTEAD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2509
Country	:	US
Telephone Number	:	216-314-5371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 HAMPSTEAD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2509
Country	:	US
Telephone Number	:	216-314-5371
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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Directions to “ LUCKY JEAN HARRIS ” Practice Location

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