Healthcare Provider Details

I. General information

NPI: 1194489344
Provider Name (Legal Business Name): MARTA KEFLOM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E MAIN ST
COLUMBUS OH
43215-5369
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-6340
  • Fax: 614-355-6347
Mailing address:
  • Phone: 614-722-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: