Healthcare Provider Details

I. General information

NPI: 1073425104
Provider Name (Legal Business Name): MILDRED ANN POINDEXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E HUDSON ST
COLUMBUS OH
43211-1034
US

IV. Provider business mailing address

5959 CENTRAL PARK DR
COLUMBUS OH
43231-2317
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-5220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLSP.00625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: