Provider Demographics
NPI:1356770424
Name:CLEVELAND HEARING AND SPEECH CENTER
Entity type:Organization
Organization Name:CLEVELAND HEARING AND SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-231-8787
Mailing Address - Street 1:11635 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4319
Mailing Address - Country:US
Mailing Address - Phone:216-231-8787
Mailing Address - Fax:216-231-7141
Practice Address - Street 1:11635 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4319
Practice Address - Country:US
Practice Address - Phone:216-231-8787
Practice Address - Fax:216-231-7141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND HEARING AND SPEECH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-08
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
OH11009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0325500Medicaid
OH1564187Medicaid