Provider Demographics
NPI:1477236420
Name:TWITTY, KENNITH EARL JR (STNA)
Entity Type:Individual
Prefix:MR
First Name:KENNITH
Middle Name:EARL
Last Name:TWITTY
Suffix:JR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7111
Mailing Address - Country:US
Mailing Address - Phone:440-506-3301
Mailing Address - Fax:
Practice Address - Street 1:329 YALE AVE
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7111
Practice Address - Country:US
Practice Address - Phone:440-506-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator