Healthcare Provider Details

I. General information

NPI: 1770477481
Provider Name (Legal Business Name): KATELYN DESKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 E STATE ST STE 8
SALEM OH
44460-2958
US

IV. Provider business mailing address

3356 GLEN OAKS DR
YOUNGSTOWN OH
44511-2030
US

V. Phone/Fax

Practice location:
  • Phone: 330-502-0712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: