Provider Demographics
NPI:1619563301
Name:GROZDANOVSKA, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:GROZDANOVSKA
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 1:2122 PICKLE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4222
Mailing Address - Country:US
Mailing Address - Phone:330-644-1609
Mailing Address - Fax:
Practice Address - Street 1:2122 PICKLE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4222
Practice Address - Country:US
Practice Address - Phone:330-644-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency