Healthcare Provider Details

I. General information

NPI: 1962314849
Provider Name (Legal Business Name): STEPHANIE CHUBB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 GROVEPORT RD
GROVEPORT OH
43125-1005
US

IV. Provider business mailing address

211 S 5TH ST
COLUMBUS OH
43215-5203
US

V. Phone/Fax

Practice location:
  • Phone: 614-567-6274
  • Fax: 855-604-0927
Mailing address:
  • Phone: 614-567-6274
  • Fax: 855-604-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: