Provider Demographics
NPI:1457628240
Name:GOCKOWSKI, AILEEN CLARE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:CLARE
Last Name:GOCKOWSKI
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2208
Mailing Address - Country:US
Mailing Address - Phone:330-677-2000
Mailing Address - Fax:330-548-0039
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2208
Practice Address - Country:US
Practice Address - Phone:330-677-2000
Practice Address - Fax:330-548-0039
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC100006101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health