Provider Demographics
NPI:1609490135
Name:REDHEAD, KRISTEN (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:REDHEAD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:REDHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:919 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1132
Mailing Address - Country:US
Mailing Address - Phone:330-454-7917
Mailing Address - Fax:
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.20048751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical