Provider Demographics
NPI:1245256601
Name:MONKOWSKI, PAUL G (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:MONKOWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5564 WILSON MILLS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3265
Mailing Address - Country:US
Mailing Address - Phone:440-461-1255
Mailing Address - Fax:
Practice Address - Street 1:5564 WILSON MILLS RD STE 201
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3265
Practice Address - Country:US
Practice Address - Phone:440-461-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE198103TC0700X
OH4037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
266426MOMedicare UPIN
OHCP24252Medicare PIN