Healthcare Provider Details

I. General information

NPI: 1649322355
Provider Name (Legal Business Name): JUDITH H. AHLBECK L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 FISHINGER RD
COLUMBUS OH
43221-2108
US

IV. Provider business mailing address

5310 E MAIN ST STE 102
COLUMBUS OH
43213-2598
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 614-457-7876
  • Fax: 614-457-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0001938
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: