Provider Demographics
NPI:1871735498
Name:STEVANOVIC, JELENA P (PHD)
Entity type:Individual
Prefix:
First Name:JELENA
Middle Name:P
Last Name:STEVANOVIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JELENA
Other - Middle Name:
Other - Last Name:PAVLOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-996-8603
Mailing Address - Fax:330-996-8695
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-4851
Practice Address - Fax:330-375-4228
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2976954Medicaid
OHCP34122Medicare PIN