Provider Demographics
NPI:1588685051
Name:OZIMEK, KENNETH J (PCC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:OZIMEK
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30400 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1872
Mailing Address - Country:US
Mailing Address - Phone:440-666-8191
Mailing Address - Fax:
Practice Address - Street 1:30400 DETROIT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1872
Practice Address - Country:US
Practice Address - Phone:440-666-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional