MEDICARE: LAKISHIA R FREEMAN

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	171M00000X	Case Manager/Care Coordinator		OH
2	172A00000X	Driver	SA245164	OH
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	186671	OH
4	172V00000X	Community Health Worker	002403	OH

General Provider Information

NPI Number	:	1649080516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHIA R FREEMAN

Provider Business Mailing Address
First Line	:	15311 EDGEWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3903
Country	:	US
Telephone Number	:	216-338-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	11806 RUTLAND AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1538
Country	:	US
Telephone Number	:	216-338-9097
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/26/2026

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Directions to “ LAKISHIA R FREEMAN ” Practice Location

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