Individual
JEANNE M LACKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-2400
(216) 844-1703
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35.091686
OH
2084P0800X
Psychiatry Physician
R7054
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2842642
—
OH
01
—
P00690302
MEDICARE RAILROAD
OH
Enumeration date
05/21/2007
Last updated
01/05/2021
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