Provider Demographics
NPI:1841795234
Name:CLINGERMAN, KRISTA LYNN
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:CLINGERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:BAINBRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3040 BELMONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1836
Mailing Address - Country:US
Mailing Address - Phone:234-228-8315
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:520 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471
Practice Address - Country:US
Practice Address - Phone:330-318-3078
Practice Address - Fax:234-855-1072
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH812009857171M00000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH812009857Medicaid