1184725251 NPI number — SHERRY WEXLER LISW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184725251 NPI number — SHERRY WEXLER LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEXLER
Provider First Name:
SHERRY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184725251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 W CREEK RD
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-986-1170
Provider Business Mailing Address Fax Number:
216-986-1016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 E AURORA RD
Provider Second Line Business Practice Location Address:
SUITE 12A
Provider Business Practice Location Address City Name:
TWINSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44087-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-986-1170
Provider Business Practice Location Address Fax Number:
216-986-1016
Provider Enumeration Date:
09/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)