Provider Demographics
NPI:1215293568
Name:GARN, KRISTEN JOANN (LSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:JOANN
Last Name:GARN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 STERKEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1578
Mailing Address - Country:US
Mailing Address - Phone:419-756-1133
Mailing Address - Fax:419-756-7456
Practice Address - Street 1:741 SCHOLL ROAD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1578
Practice Address - Country:US
Practice Address - Phone:419-756-1717
Practice Address - Fax:419-756-2594
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0800348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS0800348OtherLICENSURE