Healthcare Provider Details

I. General information

NPI: 1043128713
Provider Name (Legal Business Name): JACOB DANIEL ANDERMAN MA, EDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MADISON SCHOOL DR
COLUMBUS OH
43232-5722
US

IV. Provider business mailing address

4400 MARKETING PL STE B
GROVEPORT OH
43125-9308
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-2011
  • Fax:
Mailing address:
  • Phone: 614-492-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.03292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: