Provider Demographics
NPI:1891018578
Name:POLZNER, JAMES R (LISW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:POLZNER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 TREBISKY RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2827
Mailing Address - Country:US
Mailing Address - Phone:261-210-4702
Mailing Address - Fax:216-486-2006
Practice Address - Street 1:515 TREBISKY RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2827
Practice Address - Country:US
Practice Address - Phone:261-210-4702
Practice Address - Fax:216-486-2006
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-40221041C0700X
OHI-0004022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical