Healthcare Provider Details
I. General information
NPI: 1184216012
Provider Name (Legal Business Name): MEGAN CANNON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/11/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
444 BUTTERFLY GARDENS DR
COLUMBUS OH
43215-3427
US
IV. Provider business mailing address
700 CHILDRENS DR
COLUMBUS OH
43205-2664
US
V. Phone/Fax
- Phone: 614-355-8408
- Fax:
- Phone: 614-722-2000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | I.2405860-SUPV |
| License Number State | OH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: