Healthcare Provider Details

I. General information

NPI: 1801344262
Provider Name (Legal Business Name): KRISTIN STARR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN BISCHOFF

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SHAWNEE RD
LIMA OH
45805-3529
US

IV. Provider business mailing address

1100 SHAWNEE RD
LIMA OH
45805-3583
US

V. Phone/Fax

Practice location:
  • Phone: 419-999-2010
  • Fax: 419-999-6284
Mailing address:
  • Phone: 419-999-2010
  • Fax: 419-999-6284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901717
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0281348
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: