Krystal Devore, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1302171 Issued in OH

Practice address

246 Northland Dr
Suite 140
Medina, OH 44256-3441

Phone

(330) 723-9600

Fax

(330) 722-1446

NPI assigned

Aug 19, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1689040107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 NORTHLAND DR",
            "address_2": "SUITE 140",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442563441",
            "telephone_number": "330-723-9600",
            "fax_number": "330-722-1446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 NORTHLAND DR",
            "address_2": "SUITE 140",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442563441",
            "telephone_number": "330-723-9600",
            "fax_number": "330-722-1446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVORE",
        "first_name": "KRYSTAL",
        "credential": "LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1302171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "1302171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160326",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Webb Derrick, M.D.
• Deborah Daline Detmayer
• Kate Deville, PT, DPT
• Deborah Jane Devlin, LSW, LPCC
• Kari Devore
• Rose Barnes Dickerhoof, O.D.
• Wendy Dietrich, RPH
• Erin Dietzel
• Corey Lynn Dilalla
• Annette Dileonardo, LPN

• Clinical Social Worker in Medina, OH
• Providers in Medina, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.