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NPI Code Detail

MEDICARE: JONATHAN ANDERSON

MEDICARE: JONATHAN ANDERSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1518569300
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN ANDERSON
Provider Business Mailing Address
First Line : 5445 SMITH RD
Second Line :
City : BROOKPARK
State : OH
Zip : 44142-2026
Country : US
Telephone Number : 216-332-9360
Fax Number :
Provider Business Practice Location Address
First Line : 3951 ROCKY RIVER DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-4154
Country : US
Telephone Number : 216-675-6360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2020
Last Update Date : 11/16/2020

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Directions to “ JONATHAN ANDERSON ” Practice Location

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