Active NPI
Jennifer L Mizicko, PCC, LSW
- Mental Health Counselor
- Canton, OH
National Provider Identifier
1710126438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E0004223
- Practice address
- 4450 Belden Village St NW
Suite 304
Canton, OH 44718-2552 - Phone
- (330) 705-2550
- NPI assigned
- Feb 19, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | S0018066 | OH | |
| Mental Health Counselor | 101YM0800X | E0004223 | OH | Primary |
Addresses
Primary practice location
4450 Belden Village St NW
Suite 304
Canton, OH 44718-2552
Mailing address
3930 Thunderbird CR NW
North Canton, OH 44720
Phone (330) 705-2550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E0004223 | OH | MD | Mental Health Counselor |
| S0018066 | OH | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667260800000",
"number": "1710126438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3930 THUNDERBIRD CR NW",
"city": "NORTH CANTON",
"state": "OH",
"postal_code": "44720",
"telephone_number": "330-705-2550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4450 BELDEN VILLAGE ST NW",
"address_2": "SUITE 304",
"city": "CANTON",
"state": "OH",
"postal_code": "447182552",
"telephone_number": "330-705-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIZICKO",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "PCC, LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-19",
"last_updated": "2022-11-01",
"certification_date": "2022-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "S0018066",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E0004223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.