Healthcare Provider Details

I. General information

NPI: 1568779411
Provider Name (Legal Business Name): NORTH CANTON CITY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 7TH ST NE
NORTH CANTON OH
44720-2012
US

IV. Provider business mailing address

525 7TH ST NE
NORTH CANTON OH
44720-2012
US

V. Phone/Fax

Practice location:
  • Phone: 330-497-5665
  • Fax: 330-305-2056
Mailing address:
  • Phone: 330-497-5665
  • Fax: 330-305-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK J PONTIUS
Title or Position: SPECIAL SERVICES DIRECTOR
Credential: MASTERS DEGREE
Phone: 330-497-5665