Healthcare Provider Details

I. General information

NPI: 1043813538
Provider Name (Legal Business Name): KRISTINA MARIE DRUMMER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 10/20/2021
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TUSCARAWAS ST W
CANTON OH
44702-2044
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-8100
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-2400
  • Fax:
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-678-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901657-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: