Healthcare Provider Details

I. General information

NPI: 1902451164
Provider Name (Legal Business Name): ROKIA WEATHERSPOON ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROKIA TANNER ED.S.

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 MOCK RD
COLUMBUS OH
43219-1258
US

IV. Provider business mailing address

540 OFFICENTER PL STE 160
GAHANNA OH
43230-5351
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-8700
  • Fax:
Mailing address:
  • Phone: 614-664-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number270700
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number21174760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: