Provider Demographics
NPI:1235501362
Name:WOODWARD, KRISTYN MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:MARIE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COVINGTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1617
Mailing Address - Country:US
Mailing Address - Phone:330-480-3033
Mailing Address - Fax:330-480-2568
Practice Address - Street 1:1001 COVINGTON ST FL 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1617
Practice Address - Country:US
Practice Address - Phone:330-480-3033
Practice Address - Fax:330-480-2568
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 14512201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188245Medicaid