Healthcare Provider Details

I. General information

NPI: 1922543040
Provider Name (Legal Business Name): CODY HOSTUTLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4700
  • Fax: 614-722-4718
Mailing address:
  • Phone: 614-722-4700
  • Fax: 614-722-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberP.7520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: