Healthcare Provider Details

I. General information

NPI: 1164048435
Provider Name (Legal Business Name): CHARLES ALEXANDER KRIZMANICH LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SEVENTH ST SW
CANTON OH
44710-1801
US

IV. Provider business mailing address

30 NORTHWEST AVE STE 120
TALLMADGE OH
44278-1808
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-6242
  • Fax: 330-453-4263
Mailing address:
  • Phone: 330-663-4187
  • Fax: 614-227-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: