Provider Demographics
NPI:1245597988
Name:WRIGHT STATE UNIVERSITY
Entity type:Organization
Organization Name:WRIGHT STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MRC, PCC, LICDC
Authorized Official - Phone:937-222-2400
Mailing Address - Street 1:6 S PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2111
Mailing Address - Country:US
Mailing Address - Phone:937-222-2400
Mailing Address - Fax:937-222-7522
Practice Address - Street 1:6 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2111
Practice Address - Country:US
Practice Address - Phone:937-222-2400
Practice Address - Fax:937-222-7522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRIGHT STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0464251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC342800Medicaid
OH12961Medicare UPIN