Healthcare Provider Details

I. General information

NPI: 1366038440
Provider Name (Legal Business Name): ALEC KROH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/16/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 PARK SQUARE DR
LORAIN OH
44053-4153
US

IV. Provider business mailing address

1925 HAYES AVE
SANDUSKY OH
44870-4737
US

V. Phone/Fax

Practice location:
  • Phone: 440-984-3882
  • Fax:
Mailing address:
  • Phone: 419-557-5177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.174832
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: