Healthcare Provider Details

I. General information

NPI: 1124980552
Provider Name (Legal Business Name): KATHRYN VAJDA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29125 CHAGRIN BLVD
PEPPER PIKE OH
44122
US

IV. Provider business mailing address

29125 CHAGRIN BLVD
PEPPER PIKE OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-3999
  • Fax: 216-916-9147
Mailing address:
  • Phone: 216-292-3999
  • Fax: 216-916-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS.2513152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: