Healthcare Provider Details

I. General information

NPI: 1346642774
Provider Name (Legal Business Name): CHELSEA BENNETT LSW, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 E BROAD ST
COLUMBUS OH
43205-1156
US

IV. Provider business mailing address

51291 LAKE POINTE CT
GRANGER IN
46530-6561
US

V. Phone/Fax

Practice location:
  • Phone: 614-928-9419
  • Fax:
Mailing address:
  • Phone: 937-343-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1120348
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1100804
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: