MEDICARE: DR. JANA CLARKE PH.D.

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	103T00000X	Psychologist	5797	OH

General Provider Information

NPI Number	:	1952479354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANA CLARKE PH.D.

Provider Business Mailing Address
First Line	:	4255 HERR FIELDHOUSE RD
Second Line	:
City	:	SOUTHINGTON
State	:	OH
Zip	:	44470-9565
Country	:	US
Telephone Number	:	330-898-5012
Fax Number	:

Provider Business Practice Location Address
First Line	:	34305 SOLON RD
Second Line	:	SUITE 52
City	:	SOLON
State	:	OH
Zip	:	44139-2660
Country	:	US
Telephone Number	:	440-349-3038
Fax Number	:	440-349-8081

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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