Healthcare Provider Details

I. General information

NPI: 1134439508
Provider Name (Legal Business Name): ELIZABETH JANE SIMMONS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4897 KARL RD
COLUMBUS OH
43229-5147
US

IV. Provider business mailing address

4897 KARL RD
COLUMBUS OH
43229-5147
US

V. Phone/Fax

Practice location:
  • Phone: 614-846-2588
  • Fax: 614-846-9759
Mailing address:
  • Phone: 614-846-2588
  • Fax: 614-846-9759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1000730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: