Healthcare Provider Details

I. General information

NPI: 1396608485
Provider Name (Legal Business Name): AIDEN EDWARD DUNKLE PRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST
COLUMBUS OH
43222-1464
US

IV. Provider business mailing address

815 W BROAD ST 2ND FL, STE 200,
COLUMBUS OH
43222-1464
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-0822
  • Fax:
Mailing address:
  • Phone: 614-717-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE196820
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS007034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: