Provider Demographics
NPI:1336568120
Name:STIDD, CHRISTEN (EDS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTEN
Middle Name:
Last Name:STIDD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-3610
Mailing Address - Country:US
Mailing Address - Phone:513-398-3741
Mailing Address - Fax:
Practice Address - Street 1:4631 HICKORY WOODS LN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4517
Practice Address - Country:US
Practice Address - Phone:513-398-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3107978103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3107978OtherFIVE YEAR PROFESSIONAL LICENSE - SCHOOL PSYCHOLOGIST