Provider Demographics
NPI:1659889178
Name:KRICK, STEPHEN ANTONE (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTONE
Last Name:KRICK
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 STOWER LN UNIT 7C
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2652
Mailing Address - Country:US
Mailing Address - Phone:419-908-0209
Mailing Address - Fax:
Practice Address - Street 1:34 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2236
Practice Address - Country:US
Practice Address - Phone:567-560-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17013851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty