Provider Demographics
NPI:1225350606
Name:RORK, KRISTINE ELYSSA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELYSSA
Last Name:RORK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KARISTINE
Other - Middle Name:
Other - Last Name:VANDORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-4270
Mailing Address - Fax:330-543-4271
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4270
Practice Address - Fax:330-543-4271
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6641103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH022220Medicare PIN
OH0050371Medicaid