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NPI Code Detail

MEDICARE: AILEEN CLARE GOCKOWSKI M.ED, LPC

MEDICARE: AILEEN CLARE GOCKOWSKI M.ED, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorC100006OH
2101YM0800XMental Health CounselorC100006OH

General Provider Information

NPI Number : 1457628240
Entity Type Code : Individual
Provider Name (Legal Business Name) : AILEEN CLARE GOCKOWSKI M.ED, LPC
Provider Business Mailing Address
First Line : 420 W MAIN ST
Second Line :
City : KENT
State : OH
Zip : 44240-2208
Country : US
Telephone Number : 330-677-2000
Fax Number : 330-548-0039
Provider Business Practice Location Address
First Line : 420 W MAIN ST
Second Line :
City : KENT
State : OH
Zip : 44240-2208
Country : US
Telephone Number : 330-677-2000
Fax Number : 330-548-0039
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 11/21/2011

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