Healthcare Provider Details

I. General information

NPI: 1386949428
Provider Name (Legal Business Name): WHITNEY QUINN LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 RAVINES EDGE CT STE 301
COLUMBUS OH
43235-5423
US

IV. Provider business mailing address

PO BOX 715196
COLUMBUS OH
43271-5194
US

V. Phone/Fax

Practice location:
  • Phone: 614-896-8242
  • Fax:
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1200904-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200904-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: