Individual
BRUCE SHAGOVAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC III # 051027
Contact information
Practice address
6753 STATE RD, PARMA, OH 44134-4517
(440) 843-5617
(440) 843-5556
Mailing address
6753 STATE RD, PARMA, OH 44134-4517
(440) 843-5617
(440) 843-5556
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
051027
OH
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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