=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336712967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACLYN SHLAPACK LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2021
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 MILLER RD STE 7
-----------------------------------------------------
City | AVON LAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44012-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-742-1661
-----------------------------------------------------
Fax | 833-450-0400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 W 30TH ST
-----------------------------------------------------
City | LORAIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44052-4654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-320-0703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E.22505086
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------