Healthcare Provider Details

I. General information

NPI: 1215522115
Provider Name (Legal Business Name): ROSANNE TUCKER-SEALS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 NORTON AVE
COLUMBUS OH
43212-3181
US

IV. Provider business mailing address

398 S GRANT AVE
COLUMBUS OH
43215-5549
US

V. Phone/Fax

Practice location:
  • Phone: 614-484-0789
  • Fax:
Mailing address:
  • Phone: 614-224-2988
  • Fax: 614-716-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS0025242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: