Healthcare Provider Details

I. General information

NPI: 1609085992
Provider Name (Legal Business Name): MARK ALLEN VANHOOSE LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 BLENDON VALLEY DR
COLUMBUS OH
43230-1211
US

IV. Provider business mailing address

5632 BLENDON VALLEY DR
COLUMBUS OH
43230-1211
US

V. Phone/Fax

Practice location:
  • Phone: 937-708-6334
  • Fax:
Mailing address:
  • Phone: 937-708-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0027552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: