Healthcare Provider Details

I. General information

NPI: 1679793681
Provider Name (Legal Business Name): MS. KATHY ILENE ALDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 UPPER CHELSEA RD
COLUMBUS OH
43212-1939
US

IV. Provider business mailing address

1865 UPPER CHELSEA RD
COLUMBUS OH
43212-1939
US

V. Phone/Fax

Practice location:
  • Phone: 614-477-5720
  • Fax:
Mailing address:
  • Phone: 614-477-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number2624664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: