Provider Demographics
NPI:1952117616
Name:STROUD, RANDEE
Entity type:Individual
Prefix:
First Name:RANDEE
Middle Name:
Last Name:STROUD
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 1:2137 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5732
Mailing Address - Country:US
Mailing Address - Phone:614-381-4934
Mailing Address - Fax:
Practice Address - Street 1:2137 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5732
Practice Address - Country:US
Practice Address - Phone:614-381-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
94973205171400000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171400000XOther Service ProvidersHealth & Wellness Coach