NPI 1104309335

Andrew Grant Prendergast

Practitioner Prevention Professional Canton, OH

Practice location

Address: 601 Cleveland Ave NW, Canton, OH 44702-1836
Phone: (330) 455-0374
Fax: (330) 453-6716
Mailing address: 625 Cleveland Ave NW, Canton, OH 44702-1805

Registered specialties (2)

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence OCPSA.161356 (OH)

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Case Manager/Care Coordinator

Other Service Providers Taxonomy 171M00000X

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Registry record

NPI: 1104309335
Entity type: Individual
Sex (as registered): Male
NPI issued: 13 Sep 2018
Record last updated: 25 Oct 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.