Provider Demographics
NPI:1053582395
Name:KOLARIK, CRISSY ANN
Entity type:Individual
Prefix:
First Name:CRISSY
Middle Name:ANN
Last Name:KOLARIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISSY
Other - Middle Name:ANN
Other - Last Name:BESSEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3490 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3120
Mailing Address - Country:US
Mailing Address - Phone:330-665-1811
Mailing Address - Fax:
Practice Address - Street 1:3490 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3120
Practice Address - Country:US
Practice Address - Phone:330-665-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional