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NPI Code Detail

MEDICARE: IAN COMNICK PSYD

MEDICARE: IAN COMNICK PSYD
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
1103TC0700XClinical PsychologistP.08454OH

General Provider Information

NPI Number : 1578240776
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN COMNICK PSYD
Provider Business Mailing Address
First Line : 3585 GROSVENOR RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-2628
Country : US
Telephone Number : 440-387-9735
Fax Number :
Provider Business Practice Location Address
First Line : 10701 EAST BLVD
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1702
Country : US
Telephone Number : 440-387-9735
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2023
Last Update Date : 12/02/2025

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Directions to “ IAN COMNICK PSYD” Practice Location

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