Provider Demographics
NPI:1952991051
Name:KATRICAK, KENNETH JOHN I (LPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOHN
Last Name:KATRICAK
Suffix:I
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6305
Mailing Address - Country:US
Mailing Address - Phone:216-270-7464
Mailing Address - Fax:440-387-4706
Practice Address - Street 1:1131 E BROAD ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6305
Practice Address - Country:US
Practice Address - Phone:216-270-7464
Practice Address - Fax:440-387-4706
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN212255163WG0000X
OHC1801465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice