Provider Demographics
NPI:1710053962
Name:WARREN, KRISTAN MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:KRISTAN
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MISS
Other - First Name:KRISTAN
Other - Middle Name:MARIE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4086 COUNTY ROAD 132
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9501
Mailing Address - Country:US
Mailing Address - Phone:419-864-3762
Mailing Address - Fax:740-383-3472
Practice Address - Street 1:320 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6310
Practice Address - Country:US
Practice Address - Phone:740-387-5210
Practice Address - Fax:740-383-3472
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0008236104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical