Basic Information
| Provider Information | |||||||||
| NPI: | 1548458565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAZECK | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEMARY VAJGRT | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14 SANDALWOOD DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430559233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 SANDALWOOD DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430559233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407888850 | ||||||||
| FaxNumber: | 7407888851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.0010064 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.