Provider Demographics
NPI:1326474073
Name:STRYCZEK, KRYSTTEL CAMILLA
Entity Type:Individual
Prefix:
First Name:KRYSTTEL
Middle Name:CAMILLA
Last Name:STRYCZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 TYLER BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-8605
Mailing Address - Country:US
Mailing Address - Phone:440-266-0401
Mailing Address - Fax:440-505-0271
Practice Address - Street 1:7245 CULVER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4626
Practice Address - Country:US
Practice Address - Phone:440-266-0401
Practice Address - Fax:440-505-0271
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
OHM.1700037106H00000X
WAMG60516933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN