Individual
MRS. JACQUELINE MASSENGALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.T.
Contact information
Practice address
22001 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4819
(216) 408-8049
Mailing address
22001 FAIRMOUNT BLVD, SHAKER HEIGHTS, OH 44118-4819
(216) 408-8049
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1000340-TRNE
OH
Other
Enumeration date
03/28/2011
Last updated
03/28/2011
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