Provider Demographics
NPI:1578135513
Name:CUTHBERT, ELLEN S
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:CUTHBERT
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 1:5806 GERALD AVE LOWR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-3308
Mailing Address - Country:US
Mailing Address - Phone:440-371-1450
Mailing Address - Fax:
Practice Address - Street 1:5806 GERALD AVE LOWR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-3308
Practice Address - Country:US
Practice Address - Phone:440-371-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
OH17500000X175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist