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NPI Code Detail

MEDICARE: ANGELA GOLLADAY LISW

MEDICARE: ANGELA GOLLADAY LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1700529OH

General Provider Information

NPI Number : 1548659907
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA GOLLADAY LISW
Provider Business Mailing Address
First Line : 431 E LIVINGSTON AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-5533
Country : US
Telephone Number : 614-227-9420
Fax Number :
Provider Business Practice Location Address
First Line : 431 E LIVINGSTON AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-5533
Country : US
Telephone Number : 614-227-9420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2015
Last Update Date : 02/18/2020

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Directions to “ ANGELA GOLLADAY LISW” Practice Location

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