Healthcare Provider Details

I. General information

NPI: 1336712967
Provider Name (Legal Business Name): JACLYN SHLAPACK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MILLER RD STE 7
AVON LAKE OH
44012-1013
US

IV. Provider business mailing address

1017 W 30TH ST
LORAIN OH
44052-4654
US

V. Phone/Fax

Practice location:
  • Phone: 440-742-1661
  • Fax: 833-450-0400
Mailing address:
  • Phone: 440-320-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.22505086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: