Healthcare Provider Details

I. General information

NPI: 1720790520
Provider Name (Legal Business Name): JOSHUA STEPHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 CORLEY DR
DUBLIN OH
43016-9320
US

IV. Provider business mailing address

6280 CORLEY DR
DUBLIN OH
43016-9320
US

V. Phone/Fax

Practice location:
  • Phone: 330-423-9932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP.00700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: