Healthcare Provider Details

I. General information

NPI: 1972416097
Provider Name (Legal Business Name): NICHOLAS ROBERT KRESIC-WATSON ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 13TH ST
CUYAHOGA FALLS OH
44223-2202
US

IV. Provider business mailing address

405 TALLMADGE RD STE 2201
CUYAHOGA FALLS OH
44221-3362
US

V. Phone/Fax

Practice location:
  • Phone: 330-926-3801
  • Fax:
Mailing address:
  • Phone: 330-926-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02263
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: