Healthcare Provider Details

I. General information

NPI: 1225331663
Provider Name (Legal Business Name): ANN MARIE KENNEDY LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANN MARIE MCILROY LISW-S

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 COLLEGE AVE
COLUMBUS OH
43209-2374
US

IV. Provider business mailing address

1070 COLLEGE AVE
COLUMBUS OH
43209-2374
US

V. Phone/Fax

Practice location:
  • Phone: 614-309-1576
  • Fax: 614-921-0948
Mailing address:
  • Phone: 614-309-1576
  • Fax: 614-921-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0009445
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: