Provider Demographics
NPI:1083993927
Name:SEVERANCE, JAKLYN K (LPCC)
Entity Type:Individual
Prefix:
First Name:JAKLYN
Middle Name:K
Last Name:SEVERANCE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JAKLYN
Other - Middle Name:K
Other - Last Name:SPROSTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:866-466-9591
Mailing Address - Fax:216-712-6313
Practice Address - Street 1:CLEVELAND CLINIC 9500 EUCLID
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3437
Practice Address - Country:US
Practice Address - Phone:216-584-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0701171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional