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General NPI Number Information
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NPI Number | 1629657028
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Entity Type | Individual
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Provider Name | KRISTEN MATHIES
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 3975 KENNETH DR
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City | ROOTSTOWN
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State | OH
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Zip | 44272-9252
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Country | US
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Telephone | 330-850-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 9317 WINDING CREEK DR
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City | DIAMOND
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State | OH
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Zip | 44412-8742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CDCA.176333
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License Number State | OH
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