Provider Demographics
NPI:1205066024
Name:JONES, KRISTA M (LISW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:M
Other - Last Name:ADAMCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:3737 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5712
Mailing Address - Country:US
Mailing Address - Phone:440-324-4980
Mailing Address - Fax:440-324-4987
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9006
Practice Address - Country:US
Practice Address - Phone:440-324-4980
Practice Address - Fax:440-324-4987
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0701513104100000X
OHI.10000831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid