Basic Information
| Provider Information | |||||||||
| NPI: | 1053705715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOPKOVICH | ||||||||
| FirstName: | ALYCE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Practice Location | |||||||||
| Address1: | 5734 FREMONT PIKE | ||||||||
| Address2: | |||||||||
| City: | STONY RIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434639507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193343869 | ||||||||
| FaxNumber: | 4193348546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2015 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.0900111-S | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.