Provider Demographics
NPI:1366859571
Name:JEMISON, STEPHANIE DANEAN
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DANEAN
Last Name:JEMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 RUMSON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1357
Mailing Address - Country:US
Mailing Address - Phone:216-336-2831
Mailing Address - Fax:
Practice Address - Street 1:3440 RUMSON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1357
Practice Address - Country:US
Practice Address - Phone:216-336-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications