Provider Demographics
NPI:1073658308
Name:KALKREUTH, WILLIAM E (MED)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:KALKREUTH
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4792 MUNSON ST NW
Mailing Address - Street 2:MUNSON PROFESSIONAL CENTRE
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3630
Mailing Address - Country:US
Mailing Address - Phone:330-494-4636
Mailing Address - Fax:330-494-5861
Practice Address - Street 1:4792 MUNSON ST NW
Practice Address - Street 2:MUNSON PROFESSIONAL CENTRE
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3630
Practice Address - Country:US
Practice Address - Phone:330-494-4636
Practice Address - Fax:330-494-5861
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional