Provider Demographics
NPI:1588455836
Name:HENNESSEE, CHAZ
Entity type:Individual
Prefix:
First Name:CHAZ
Middle Name:
Last Name:HENNESSEE
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 1:4400 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3734
Mailing Address - Country:US
Mailing Address - Phone:216-431-5800
Mailing Address - Fax:
Practice Address - Street 1:16808 MADISON AVE APT 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5419
Practice Address - Country:US
Practice Address - Phone:216-209-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program