Provider Demographics
NPI:1407236391
Name:JANEZIC, KACI L (LISW-S)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:L
Last Name:JANEZIC
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:L
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1217
Mailing Address - Country:US
Mailing Address - Phone:440-234-2006
Mailing Address - Fax:440-260-8305
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3441
Practice Address - Country:US
Practice Address - Phone:440-260-8300
Practice Address - Fax:440-260-8575
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.700580-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical