Healthcare Provider Details

I. General information

NPI: 1639440027
Provider Name (Legal Business Name): JASON ZAVODNY LPCC-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E WATERLOO RD
AKRON OH
44306-3805
US

IV. Provider business mailing address

1221 E WATERLOO RD
AKRON OH
44306-3805
US

V. Phone/Fax

Practice location:
  • Phone: 234-208-4320
  • Fax:
Mailing address:
  • Phone: 234-208-4320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1000575-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: