Healthcare Provider Details

I. General information

NPI: 1720077027
Provider Name (Legal Business Name): JOHN M SHOWALTER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 W 5TH AVE SUITE 2
COLUMBUS OH
43212-1905
US

IV. Provider business mailing address

1971 W 5TH AVE SUITE 2
COLUMBUS OH
43212-1905
US

V. Phone/Fax

Practice location:
  • Phone: 614-748-8628
  • Fax: 614-488-9592
Mailing address:
  • Phone: 614-488-6285
  • Fax: 614-488-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: