Healthcare Provider Details

I. General information

NPI: 1285792077
Provider Name (Legal Business Name): EDWARD JOHN WOJNIAK JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 N. HIGH STREET SUITE 209
COLUMBUS OH
43214-3643
US

IV. Provider business mailing address

3620 N. HIGH STREET SUITE 209
COLUMBUS OH
43214
US

V. Phone/Fax

Practice location:
  • Phone: 614-268-3939
  • Fax: 614-269-3949
Mailing address:
  • Phone: 614-268-3939
  • Fax: 614-269-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: