Healthcare Provider Details

I. General information

NPI: 1174756654
Provider Name (Legal Business Name): SCHOLAR TAKEM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 E BROAD ST 3RD FLOOR
COLUMBUS OH
43205-1156
US

IV. Provider business mailing address

899 E BROAD ST 3RD FLOOR
COLUMBUS OH
43205-1156
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8000
  • Fax: 614-355-8018
Mailing address:
  • Phone: 614-355-8000
  • Fax: 614-355-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0900507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: