Provider Demographics
NPI:1497179139
Name:RIBOVICH, KATHRYN T (PCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:T
Last Name:RIBOVICH
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:D
Other - Last Name:TISSUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCC
Mailing Address - Street 1:5108 DARROW RD # 5
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5018
Mailing Address - Country:US
Mailing Address - Phone:419-699-2778
Mailing Address - Fax:
Practice Address - Street 1:5868 STUMPH RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1736
Practice Address - Country:US
Practice Address - Phone:440-888-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSK439363Medicaid