Healthcare Provider Details

I. General information

NPI: 1538178579
Provider Name (Legal Business Name): ZEV W COMPTON LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28784 JOHNSON DR
WICKLIFFE OH
44092
US

IV. Provider business mailing address

28784 JOHNSON DR
WICKLIFFE OH
44092
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-3052
  • Fax:
Mailing address:
  • Phone: 440-943-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: