Basic Information
| Provider Information | |||||||||
| NPI: | 1518437938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTEP | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 994 VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402429990 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1865 N RIDGE RD E STE E | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440553360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407235501 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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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 | S.0909225 | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | S.0909225 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.