Healthcare Provider Details

I. General information

NPI: 1326287319
Provider Name (Legal Business Name): SIEMA A ELJACK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 N HIGH ST
COLUMBUS OH
43201-2409
US

IV. Provider business mailing address

1033 N HIGH ST
COLUMBUS OH
43201-2409
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-6777
  • Fax:
Mailing address:
  • Phone: 614-340-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS2207764
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberP57285
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: