MEDICARE: JEANNETTE LOGAN-LANE MSW

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	104100000X	Social Worker	S.0901024	OH

General Provider Information

NPI Number	:	1770057820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE LOGAN-LANE MSW

Provider Business Mailing Address
First Line	:	24323 SEDLEY RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1305
Country	:	US
Telephone Number	:	216-244-0497
Fax Number	:

Provider Business Practice Location Address
First Line	:	24323 SEDLEY RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-1305
Country	:	US
Telephone Number	:	216-244-0497
Fax Number	:

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

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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Directions to “ JEANNETTE LOGAN-LANE MSW” Practice Location

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