MEDICARE: STEPHEN M. REDLE PHD

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	103T00000X	Psychologist	5555	OH

General Provider Information

NPI Number	:	1346316742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN M. REDLE PHD

Provider Business Mailing Address
First Line	:	2321 2ND ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-2520
Country	:	US
Telephone Number	:	330-926-0760
Fax Number	:	330-926-1944

Provider Business Practice Location Address
First Line	:	2321 2ND ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-2520
Country	:	US
Telephone Number	:	330-926-0760
Fax Number	:	330-926-1944

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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