Provider Demographics
NPI:1184047680
Name:STUTZMAN, KRISTEN
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9668
Mailing Address - Country:US
Mailing Address - Phone:330-435-6383
Mailing Address - Fax:
Practice Address - Street 1:286 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217
Practice Address - Country:US
Practice Address - Phone:330-435-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184047680Medicaid