Individual
KENYETTA S DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
131 WERTZ AVE NW, CANTON, OH 44708-4171
(234) 214-8470
(234) 214-8471
Mailing address
131 WERTZ AVE. NW, CANTON, OH 44708-4171
(234) 214-8470
(234) 214-8471
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS.005628
OH
Other
Enumeration date
03/27/2025
Last updated
03/27/2025
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