MEDICARE: JACQUELYN STEPHENS

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	372500000X	Chore Provider

General Provider Information

NPI Number	:	1932917697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN STEPHENS

Provider Business Mailing Address
First Line	:	3825 MAYFIELD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1748
Country	:	US
Telephone Number	:	216-800-2832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 MAYFIELD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1748
Country	:	US
Telephone Number	:	216-800-2832
Fax Number	:

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

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	12/26/2024

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Directions to “ JACQUELYN STEPHENS ” Practice Location

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