Healthcare Provider Details

I. General information

NPI: 1083074561
Provider Name (Legal Business Name): MICHELLE MEFFLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3516
US

IV. Provider business mailing address

241 BOLLINGEN
BLACKLICK OH
43004-8263
US

V. Phone/Fax

Practice location:
  • Phone: 614-813-1083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502007
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: