Provider Demographics
NPI:1003408428
Name:VANZILE, JACQUELYN (LPCC)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:VANZILE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 MONROE ST BLDG G
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2211
Practice Address - Country:US
Practice Address - Phone:419-824-6350
Practice Address - Fax:419-822-3847
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901935101YM0800X
OHE.2202913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health