Basic Information
| Provider Information | |||||||||
| NPI: | 1134427214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISTERKA | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSSA, LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 MIDWAY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440359006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407235494 | ||||||||
| FaxNumber: | 4403249978 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 MIDWAY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440359006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407235494 | ||||||||
| FaxNumber: | 4403249978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2011 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I. 1101325 .SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.