Provider Demographics
NPI:1508245150
Name:JESWALD, MARIANNE (PC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:JESWALD
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23875 COMMERCE PARK
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-401-1509
Mailing Address - Fax:216-464-4693
Practice Address - Street 1:23875 COMMERCE PARK
Practice Address - Street 2:SUITE 130
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-401-1509
Practice Address - Fax:216-464-4693
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0005342101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor