Healthcare Provider Details

I. General information

NPI: 1265343610
Provider Name (Legal Business Name): DEBBIE SUZANNE KRUPPA LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HOAGLAND BLACKSTUB RD NE
WARREN OH
44481-9328
US

IV. Provider business mailing address

418 DURST DR NW
WARREN OH
44483-1108
US

V. Phone/Fax

Practice location:
  • Phone: 330-219-1129
  • Fax:
Mailing address:
  • Phone: 330-219-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI.0005679-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.0005679-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: