Healthcare Provider Details

I. General information

NPI: 1710399969
Provider Name (Legal Business Name): DANNELLE BAGNOLI HARENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
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

3425 SAINT CHARLES LN
HILLIARD OH
43026-5736
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-5220
  • Fax:
Mailing address:
  • Phone: 614-432-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1312908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: