Provider Demographics
NPI:1134427214
Name:MISTERKA, KATHERINE A (MSSA, LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:MISTERKA
Suffix:
Gender:F
Credentials:MSSA, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MIDWAY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-9006
Mailing Address - Country:US
Mailing Address - Phone:440-723-5494
Mailing Address - Fax:440-324-9978
Practice Address - Street 1:347 MIDWAY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9006
Practice Address - Country:US
Practice Address - Phone:440-723-5494
Practice Address - Fax:440-324-9978
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 1101325 .SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical