Healthcare Provider Details

I. General information

NPI: 1841027331
Provider Name (Legal Business Name): VEDRAN OKILJ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAPLE AVE
GREENSBURG PA
15601-3216
US

IV. Provider business mailing address

230 INDIAN ST
LIGONIER PA
15658-1008
US

V. Phone/Fax

Practice location:
  • Phone: 724-834-0420
  • Fax:
Mailing address:
  • Phone: 717-491-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141517
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: