Healthcare Provider Details

I. General information

NPI: 1952896219
Provider Name (Legal Business Name): JANIE L WITHROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S CENTRAL AVE
COLUMBUS OH
43223-1301
US

IV. Provider business mailing address

3006 UPTON RD E
COLUMBUS OH
43232-5240
US

V. Phone/Fax

Practice location:
  • Phone: 614-276-2273
  • Fax:
Mailing address:
  • Phone: 404-295-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0002559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: