Healthcare Provider Details

I. General information

NPI: 1528608072
Provider Name (Legal Business Name): KRYSTAL LEIGH BURROWS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23366 COMMERCE PARK STE 100B
BEACHWOOD OH
44122-5801
US

IV. Provider business mailing address

7020 CANTON RD NW
MALVERN OH
44644-9717
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2400
  • Fax:
Mailing address:
  • Phone: 303-691-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: