Provider Demographics
NPI:1194216796
Name:PERKOWSKI, KELSEY (ECMH)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PERKOWSKI
Suffix:
Gender:F
Credentials:ECMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:625 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1805
Practice Address - Country:US
Practice Address - Phone:330-445-2677
Practice Address - Fax:330-455-2101
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTK846577OtherDRIVER LICENSE