Provider Demographics
NPI:1427361500
Name:BOZICK, DANNA (LSW, NCC, LICDC, CTT)
Entity Type:Individual
Prefix:MS
First Name:DANNA
Middle Name:
Last Name:BOZICK
Suffix:
Gender:F
Credentials:LSW, NCC, LICDC, CTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3311
Mailing Address - Country:US
Mailing Address - Phone:330-259-3664
Mailing Address - Fax:330-259-3665
Practice Address - Street 1:4505 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3311
Practice Address - Country:US
Practice Address - Phone:330-259-3664
Practice Address - Fax:330-259-3665
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22869101YM0800X
OH0910-C02101YA0400X
OH981384101YA0400X
OH601948101YP2500X
OH701089101YA0400X
OH167101YA0400X
OHS.00163701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032571Medicaid
OH9316671Medicare PIN