Provider Demographics
NPI:1336712967
Name:SHLAPACK, JACLYN (LPC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SHLAPACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-4654
Mailing Address - Country:US
Mailing Address - Phone:440-320-0703
Mailing Address - Fax:
Practice Address - Street 1:400 TENNEY AVE STE 118
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2268
Practice Address - Country:US
Practice Address - Phone:440-766-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty