MEDICARE: JASON ZAVODNY LPCC-S

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
1	101YM0800X	Mental Health Counselor	E.1000575-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13765852	OTHER	OH	CAQH PROVIDER

General Provider Information

NPI Number	:	1639440027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ZAVODNY LPCC-S

Provider Business Mailing Address
First Line	:	1221 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3805
Country	:	US
Telephone Number	:	234-208-4320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3805
Country	:	US
Telephone Number	:	234-208-4320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	12/10/2020

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