Healthcare Provider Details

I. General information

NPI: 1336662006
Provider Name (Legal Business Name): KRISTINA YAUCH LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA MUCHA

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 CENTRAL AVE
MIDDLETOWN OH
45044-5239
US

IV. Provider business mailing address

4406 CENTRAL AVE
MIDDLETOWN OH
45044-5239
US

V. Phone/Fax

Practice location:
  • Phone: 513-594-5192
  • Fax:
Mailing address:
  • Phone: 513-594-5192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1600115-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: