Healthcare Provider Details

I. General information

NPI: 1356259139
Provider Name (Legal Business Name): MADELYN VRTACNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 ENGLE RD STE D
MIDDLEBURG HEIGHTS OH
44130-3459
US

IV. Provider business mailing address

6908 ENGLE RD STE D
MIDDLEBURG HEIGHTS OH
44130-3459
US

V. Phone/Fax

Practice location:
  • Phone: 216-321-0720
  • Fax: 866-571-7395
Mailing address:
  • Phone: 216-321-0720
  • Fax: 866-571-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-272840
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: