Healthcare Provider Details

I. General information

NPI: 1144749441
Provider Name (Legal Business Name): CHELSEA KANE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MEDICAL CENTER DR RM 2145
COLUMBUS OH
43210-1229
US

IV. Provider business mailing address

480 MEDICAL CENTER DR
COLUMBUS OH
43210-1229
US

V. Phone/Fax

Practice location:
  • Phone: 317-507-7427
  • Fax:
Mailing address:
  • Phone: 614-293-7604
  • Fax: 614-366-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberP.07598
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.07598
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: