Provider Demographics
NPI:1114584901
Name:CLOUD, GLORIA JEAN (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:CLOUD
Suffix:
Gender:
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2451
Mailing Address - Country:US
Mailing Address - Phone:216-307-1505
Mailing Address - Fax:
Practice Address - Street 1:3986 BLUESTONE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2451
Practice Address - Country:US
Practice Address - Phone:216-307-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA167079101YA0400X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)