Healthcare Provider Details

I. General information

NPI: 1457628240
Provider Name (Legal Business Name): AILEEN CLARE GOCKOWSKI M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MAIN ST
KENT OH
44240-2208
US

IV. Provider business mailing address

420 W MAIN ST
KENT OH
44240-2208
US

V. Phone/Fax

Practice location:
  • Phone: 330-677-2000
  • Fax: 330-548-0039
Mailing address:
  • Phone: 330-677-2000
  • Fax: 330-548-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC100006
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC100006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: