Provider Demographics
NPI:1659126548
Name:CHANEY, JAZZMAN
Entity type:Individual
Prefix:
First Name:JAZZMAN
Middle Name:
Last Name:CHANEY
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 1:24101 LAKE SHORE BLVD APT 902A
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-4211
Mailing Address - Country:US
Mailing Address - Phone:440-610-0155
Mailing Address - Fax:
Practice Address - Street 1:24101 LAKE SHORE BLVD APT 902A
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-4211
Practice Address - Country:US
Practice Address - Phone:440-610-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator