Healthcare Provider Details

I. General information

NPI: 1710491949
Provider Name (Legal Business Name): TERRA VAJCNER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5174 BLAZER PKWY
DUBLIN OH
43017-1339
US

IV. Provider business mailing address

5174 BLAZER PKWY
DUBLIN OH
43017-1339
US

V. Phone/Fax

Practice location:
  • Phone: 614-792-9104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.07649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: