Healthcare Provider Details

I. General information

NPI: 1659312486
Provider Name (Legal Business Name): LINDA CORLIS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 W 5TH AVE SUITE 2
COLUMBUS OH
43212-1905
US

IV. Provider business mailing address

1971 W 5TH AVE
COLUMBUS OH
43212-1905
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-6285
  • Fax:
Mailing address:
  • Phone: 614-488-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-0001532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: