Healthcare Provider Details

I. General information

NPI: 1457543480
Provider Name (Legal Business Name): LAUREN ELIZABETH FISH LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W BROAD ST
COLUMBUS OH
43204-2653
US

IV. Provider business mailing address

1495 MORSE RD STE B3
COLUMBUS OH
43229-6478
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-7003
  • Fax: 614-279-7695
Mailing address:
  • Phone: 614-267-7003
  • Fax: 614-267-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS 0700853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: