Healthcare Provider Details

I. General information

NPI: 1366934028
Provider Name (Legal Business Name): SARAH MICHELLE WUNDERLICH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH MICHELLE HOLMES LISW

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • Fax: 614-889-9335
Mailing address:
  • Phone: 614-889-5722
  • Fax: 614-889-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1100716
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1801308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: