Provider Demographics
NPI:1497497770
Name:CLINKSCALES, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CLINKSCALES
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 1:17802 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1232
Mailing Address - Country:US
Mailing Address - Phone:216-848-8576
Mailing Address - Fax:
Practice Address - Street 1:17802 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1232
Practice Address - Country:US
Practice Address - Phone:216-848-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health