Provider Demographics
NPI:1184343089
Name:MANN, KRISTA ANN (LISW-S)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:MANN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:ANN
Other - Last Name:WESSENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6525 CHERRY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7636
Mailing Address - Country:US
Mailing Address - Phone:513-543-7510
Mailing Address - Fax:
Practice Address - Street 1:6525 CHERRY LEAF CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7636
Practice Address - Country:US
Practice Address - Phone:513-543-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801118-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker