Individual
CORLETTE GANTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2202 E 80TH ST, CLEVELAND, OH 44103-4951
(216) 324-3014
Mailing address
2202 E 80TH ST, CLEVELAND, OH 44103-4951
(216) 324-3014
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000270847
—
OH
Enumeration date
12/23/2020
Last updated
12/23/2020
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