| Doctor Name: | REBECCA M KONDRICH |
| NPI Number: | 1093157232 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LSW |
| License Number: | S.1302750 |
| Business Practice Address: | 347 Midway Blvd Suite 204 Elyria, OH - 440359006 |
| Business Phone Number: | 4403244980 |
| Business Fax Number: | 2163783906 |
| Mailing Address: | 3737 Lander Rd, PEPPER PIKE |
| State: | OH |
| Postal Code: | 441245712 |
| Phone Number: | 2168312255 |
| Fax Number: | 2163783906 |
| NPI Enumeration Date: | 07/29/2013 |
| NPI Last Update Date: | 07/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S.1302750 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |