Provider Demographics
NPI:1669695235
Name:STREIDL, CHRISTOPHER MICHAEL (LISW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:STREIDL
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 95
Mailing Address - Street 2:207 W MAIN STREET
Mailing Address - City:PORTAGE
Mailing Address - State:OH
Mailing Address - Zip Code:43451
Mailing Address - Country:US
Mailing Address - Phone:419-704-0769
Mailing Address - Fax:
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:MAIL STOP 1161
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3521
Practice Address - Fax:419-383-3277
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0031093104100000X
OHI-08001081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI-0800108OtherLISW
OHS0031093OtherLSW