Healthcare Provider Details

I. General information

NPI: 1386008480
Provider Name (Legal Business Name): KRISTINA CLINGAN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6076 SILVERWOOD ST
COLUMBUS OH
43229-2823
US

IV. Provider business mailing address

6076 SILVERWOOD ST
COLUMBUS OH
43229-2823
US

V. Phone/Fax

Practice location:
  • Phone: 740-417-2805
  • Fax:
Mailing address:
  • Phone: 740-417-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0600623
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: