Organization
KENNA R MYCEK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNA MYCEK (AUTHORIZED OFFICIAL)
(216) 534-0907
Entity
Organization
Contact information
Practice address
27101 E OVIATT RD, #2, BAY VILLAGE, OH 44140-3307
(216) 534-0907
Mailing address
27101 E OVIATT RD, #2, BAY VILLAGE, OH 44140-3307
(216) 534-0907
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
RW689718
OH
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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