Provider Demographics
NPI:1902396435
Name:YANTKO, AARON DAVID (MA , LPC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:YANTKO
Suffix:
Gender:M
Credentials:MA , LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 MONROE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-5306
Mailing Address - Country:US
Mailing Address - Phone:216-217-2316
Mailing Address - Fax:
Practice Address - Street 1:457 GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2304
Practice Address - Country:US
Practice Address - Phone:440-406-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1400280OtherCSWMFT BOARD