Healthcare Provider Details

I. General information

NPI: 1104286905
Provider Name (Legal Business Name): KRISTINA FRYSON MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 DRESSLER RD NW STE 112
CANTON OH
44718-2576
US

IV. Provider business mailing address

7519 MENTOR AVE STE 114
MENTOR OH
44060-5410
US

V. Phone/Fax

Practice location:
  • Phone: 330-765-5160
  • Fax: 440-527-8043
Mailing address:
  • Phone: 440-701-6170
  • Fax: 440-527-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2304473
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: