Healthcare Provider Details

I. General information

NPI: 1326474073
Provider Name (Legal Business Name): KRYSTTEL CAMILLA STRYCZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7245 CULVER BLVD
MENTOR OH
44060-4626
US

IV. Provider business mailing address

8600 TYLER BLVD UNIT 102
MENTOR OH
44061-8605
US

V. Phone/Fax

Practice location:
  • Phone: 440-266-0401
  • Fax: 440-505-0271
Mailing address:
  • Phone: 440-266-0401
  • Fax: 440-505-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.1700037
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: