Healthcare Provider Details

I. General information

NPI: 1023920717
Provider Name (Legal Business Name): KRISTA M SWIHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 EATON LEWISBURG RD
EATON OH
45320-1105
US

IV. Provider business mailing address

39 S MAIN ST
WEST ALEXANDRIA OH
45381-1245
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-1109
  • Fax:
Mailing address:
  • Phone: 937-456-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: