Active NPI
Kristine Michelle Quallich, PH.D.
- Psychologist
- Medina, OH
National Provider Identifier
1841946019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6408
- Practice address
- 4080 Preserve Run Cir
Medina, OH 44256-6431 - Phone
- (216) 299-1889
- NPI assigned
- Feb 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6408 | OH | Primary |
Addresses
Primary practice location
4080 Preserve Run Cir
Medina, OH 44256-6431
Mailing address
4080 Preserve Run Cir
Medina, OH 44256-6431
Phone (216) 299-1889
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6408 | OH | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Medical of Ca PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatry Physician
- San Jose, CA
- NPI 1942935473
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645833600000",
"number": "1841946019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4080 PRESERVE RUN CIR",
"city": "MEDINA",
"state": "OH",
"postal_code": "442566431",
"telephone_number": "216-299-1889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4080 PRESERVE RUN CIR",
"city": "MEDINA",
"state": "OH",
"postal_code": "442566431",
"telephone_number": "216-299-1889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUALLICH",
"first_name": "KRISTINE",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-26",
"last_updated": "2022-02-26",
"certification_date": "2022-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "6408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.