Individual
TAWANNA JEANIE BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4032 RIDGE RD APT 5, BROOKLYN, OH 44144-1408
(216) 856-0495
Mailing address
4032 RIDGE RD APT 5, BROOKLYN, OH 44144-1408
(216) 856-0495
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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