Provider Demographics
NPI:1346338308
Name:SHONTZ, KIMBERLY (LISW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:SHONTZ
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 1:150 CROSS STREET
Mailing Address - Street 2:COMMUNITY SUPPORT SERVICES INC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311
Mailing Address - Country:US
Mailing Address - Phone:330-253-9388
Mailing Address - Fax:330-376-6726
Practice Address - Street 1:150 CROSS STREET
Practice Address - Street 2:COMMUNITY SUPPORT SERVICES INC
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311
Practice Address - Country:US
Practice Address - Phone:330-253-9388
Practice Address - Fax:330-376-6726
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005750104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker