Basic Information
| Provider Information | |||||||||
| NPI: | 1417258005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEAD | ||||||||
| FirstName: | CRISTEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4449 STATE ROUTE 159 | ||||||||
| Address2: | P.O. BOX 6179 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751260 | ||||||||
| FaxNumber: | 7407731264 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451231365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379817701 | ||||||||
| FaxNumber: | 9379812054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2010 | ||||||||
| LastUpdateDate: | 11/12/2010 | ||||||||
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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 | 104100000X | S0025246 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.