Healthcare Provider Details

I. General information

NPI: 1366851057
Provider Name (Legal Business Name): LONDA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E HUDSON ST
COLUMBUS OH
43211-1034
US

IV. Provider business mailing address

4508 SMOKEY PL
COLUMBUS OH
43230-1130
US

V. Phone/Fax

Practice location:
  • Phone: 614-746-2504
  • Fax:
Mailing address:
  • Phone: 614-746-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1185792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: