Provider Demographics
NPI:1205871985
Name:KENT STATE UNIVERSITY
Entity type:Organization
Organization Name:KENT STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT, STUDENT A
Authorized Official - Prefix:
Authorized Official - First Name:CESQUINN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-672-1007
Mailing Address - Street 1:1500 EASTWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-0001
Mailing Address - Country:US
Mailing Address - Phone:330-672-8245
Mailing Address - Fax:330-672-3711
Practice Address - Street 1:1500 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-0001
Practice Address - Country:US
Practice Address - Phone:330-672-8194
Practice Address - Fax:330-672-2272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENT STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty