Provider Demographics
NPI:1629479985
Name:KRAYNAK, AUDREY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:R
Last Name:KRAYNAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 FORESTHILL RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1953
Mailing Address - Country:US
Mailing Address - Phone:330-673-0671
Mailing Address - Fax:
Practice Address - Street 1:4446 FORESTHILL RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1953
Practice Address - Country:US
Practice Address - Phone:330-673-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 338103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool