MEDICARE: JASMINE KOCHHEISER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	181259	OH

General Provider Information

NPI Number	:	1912625088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE KOCHHEISER

Provider Business Mailing Address
First Line	:	2827 OAK PARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5433
Country	:	US
Telephone Number	:	216-215-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 TURNEY RD
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2546
Country	:	US
Telephone Number	:	216-633-1334
Fax Number	:

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

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/16/2022

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Directions to “ JASMINE KOCHHEISER ” Practice Location

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