Healthcare Provider Details

I. General information

NPI: 1982907416
Provider Name (Legal Business Name): ANDREA N. WITWER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 DODD DR
COLUMBUS OH
43210-1257
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3276
  • Fax: 614-366-6373
Mailing address:
  • Phone: 614-292-5123
  • Fax: 614-247-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6725
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: