Healthcare Provider Details

I. General information

NPI: 1003730698
Provider Name (Legal Business Name): JOHNEL MARIE AMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S HAMILTON RD
GAHANNA OH
43230-2919
US

IV. Provider business mailing address

140 S HAMILTON RD
GAHANNA OH
43230-2919
US

V. Phone/Fax

Practice location:
  • Phone: 614-479-1318
  • Fax:
Mailing address:
  • Phone: 614-479-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: