Healthcare Provider Details

I. General information

NPI: 1871735498
Provider Name (Legal Business Name): JELENA P STEVANOVIC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JELENA PAVLOVIC

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST SUITE 104
AKRON OH
44304-1429
US

IV. Provider business mailing address

525 E MARKET ST PO BOX 2090
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-4851
  • Fax: 330-375-4228
Mailing address:
  • Phone: 330-996-8603
  • Fax: 330-996-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: