Healthcare Provider Details

I. General information

NPI: 1619109675
Provider Name (Legal Business Name): MRS. LYNN MARIE REPKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 W WATERLOO RD
AKRON OH
44319-1131
US

IV. Provider business mailing address

95 W WATERLOO RD
AKRON OH
44319-1131
US

V. Phone/Fax

Practice location:
  • Phone: 330-724-7715
  • Fax: 330-724-1080
Mailing address:
  • Phone: 330-724-7715
  • Fax: 330-724-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: