Healthcare Provider Details

I. General information

NPI: 1003276668
Provider Name (Legal Business Name): AMY ZEGLEN PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 S PORTAGE PATH
AKRON OH
44320-2326
US

IV. Provider business mailing address

725 E MARKET ST
AKRON OH
44305-2421
US

V. Phone/Fax

Practice location:
  • Phone: 330-315-4918
  • Fax:
Mailing address:
  • Phone: 330-434-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE. 0808098
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE. 0808098
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: