Healthcare Provider Details

I. General information

NPI: 1376990697
Provider Name (Legal Business Name): MARIAN GRACE STUCKEY MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 02/28/2022
Certification Date: 02/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

IV. Provider business mailing address

1560 FISHINGER ROAD
COLUMBUS OH
43221-2108
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5722
  • 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 Number51440455
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: