Provider Demographics
NPI:1881271815
Name:DULIN, KYRSTIN ANNE
Entity type:Individual
Prefix:
First Name:KYRSTIN
Middle Name:ANNE
Last Name:DULIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 STATE ROUTE 96 E
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:OH
Mailing Address - Zip Code:44878-9131
Mailing Address - Country:US
Mailing Address - Phone:419-961-4068
Mailing Address - Fax:
Practice Address - Street 1:1033 LARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2424
Practice Address - Country:US
Practice Address - Phone:419-747-4122
Practice Address - Fax:419-747-4126
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUT013785106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician