Healthcare Provider Details

I. General information

NPI: 1669016440
Provider Name (Legal Business Name): SAMANTHA M. HULETT LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

V. Phone/Fax

Practice location:
  • Phone: 614-366-3238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: