Healthcare Provider Details

I. General information

NPI: 1821897778
Provider Name (Legal Business Name): ASHLEY WEISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

5454 FRANK AVE NW
NORTH CANTON OH
44720-7536
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7917
  • Fax:
Mailing address:
  • Phone: 330-949-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: