Provider Demographics
NPI:1194535427
Name:ELLISON, GERALDINE LINNETTE
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:LINNETTE
Last Name:ELLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 KEMPER RD APT 308
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1269
Mailing Address - Country:US
Mailing Address - Phone:216-288-1353
Mailing Address - Fax:
Practice Address - Street 1:2450 FAIRMOUNT BLVD # M140
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3100
Practice Address - Country:US
Practice Address - Phone:440-625-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator