Healthcare Provider Details

I. General information

NPI: 1508077462
Provider Name (Legal Business Name): ANN MARIE PHILLIPS BSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

567 S EVERETT AVE
COLUMBUS OH
43213-2723
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0731
  • Fax: 614-252-8468
Mailing address:
  • Phone: 614-237-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0031071
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: