Provider Demographics
NPI:1447864145
Name:VONSPIEGEL, JONATHAN D
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:VONSPIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 ENTERPRISE DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-8706
Mailing Address - Country:US
Mailing Address - Phone:330-787-0955
Mailing Address - Fax:
Practice Address - Street 1:4930 ENTERPRISE DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-8706
Practice Address - Country:US
Practice Address - Phone:330-787-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174347101Y00000X
OH174347324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselor