Provider Demographics
NPI:1114341062
Name:SLEJKO, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SLEJKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3114
Mailing Address - Country:US
Mailing Address - Phone:440-392-5060
Mailing Address - Fax:440-392-5259
Practice Address - Street 1:58 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3114
Practice Address - Country:US
Practice Address - Phone:440-392-5060
Practice Address - Fax:440-392-5259
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1229152103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool