Healthcare Provider Details

I. General information

NPI: 1164556775
Provider Name (Legal Business Name): KEVIN HEPNER LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 E BROAD ST FL 3 CHILDREN'S HOSPITAL GUIDANCE CENTER
COLUMBUS OH
43205-1156
US

IV. Provider business mailing address

899 E BROAD ST FL 3 CHILDREN'S HOSPITAL GUIDANCE CENTER
COLUMBUS OH
43205-1156
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8000
  • Fax: 614-355-8018
Mailing address:
  • Phone: 614-355-8000
  • Fax: 614-355-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0005883
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: