Healthcare Provider Details

I. General information

NPI: 1164923660
Provider Name (Legal Business Name): KIRSTIN MONIQUE TRENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 COMMERCE DR
PERRYSBURG OH
43551-5267
US

IV. Provider business mailing address

885 COMMERCE DR
PERRYSBURG OH
43551-5267
US

V. Phone/Fax

Practice location:
  • Phone: 419-330-1349
  • Fax:
Mailing address:
  • Phone: 419-330-1349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: