Provider Demographics
NPI:1720498827
Name:CHESHIRE, KRISTIN MICHELE (MED, EDS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELE
Last Name:CHESHIRE
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 STEESE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7712
Mailing Address - Country:US
Mailing Address - Phone:330-896-7700
Mailing Address - Fax:330-896-7725
Practice Address - Street 1:1737 STEESE RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7712
Practice Address - Country:US
Practice Address - Phone:330-896-7700
Practice Address - Fax:330-896-7725
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHKU1039141103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool