Healthcare Provider Details

I. General information

NPI: 1184486037
Provider Name (Legal Business Name): KAYLEE MARIE BUZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 E GLENWOOD AVE
AKRON OH
44304-1137
US

IV. Provider business mailing address

3976 MASSILLON RD APT B
UNIONTOWN OH
44685-8762
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-2222
  • Fax:
Mailing address:
  • Phone: 330-671-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.186117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: