Healthcare Provider Details

I. General information

NPI: 1508509944
Provider Name (Legal Business Name): KATELYN JEAN NEELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

IV. Provider business mailing address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

V. Phone/Fax

Practice location:
  • Phone: 614-227-9444
  • Fax:
Mailing address:
  • Phone: 614-227-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2309419
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1041C0700X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: