Provider Demographics
NPI:1487785267
Name:DEVRIES, KRISTY YVONNE (LISW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:YVONNE
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:YVONNE
Other - Last Name:BLAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:
Practice Address - Street 1:4615 HILTON CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-729-2024
Practice Address - Fax:614-729-2030
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI70231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical