Provider Demographics
NPI:1053772749
Name:VIZYAK, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:VIZYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WINDHAM COURT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5083
Mailing Address - Country:US
Mailing Address - Phone:330-629-2955
Mailing Address - Fax:330-629-2956
Practice Address - Street 1:950 WINDHAM CT
Practice Address - Street 2:SUITE 4
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5083
Practice Address - Country:US
Practice Address - Phone:330-629-2955
Practice Address - Fax:330-629-2956
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156787103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst