Provider Demographics
NPI:1790922102
Name:CLEVELAND, LCSW, PLLC, JOHANNA (JODY) H (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA (JODY)
Middle Name:H
Last Name:CLEVELAND, LCSW, PLLC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5350 S ROSLYN ST STE 306
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2124
Mailing Address - Country:US
Mailing Address - Phone:303-885-7169
Mailing Address - Fax:303-779-3341
Practice Address - Street 1:5350 S ROSLYN ST STE 306
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2124
Practice Address - Country:US
Practice Address - Phone:303-885-7169
Practice Address - Fax:303-779-3341
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical