Healthcare Provider Details

I. General information

NPI: 1588491799
Provider Name (Legal Business Name): ELLEN EILEEN POLLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 LINWOOD RD
PLEASANT CITY OH
43772-9714
US

IV. Provider business mailing address

10400 BLACKLICK EASTERN RD
PICKERINGTON OH
43147-8235
US

V. Phone/Fax

Practice location:
  • Phone: 740-260-3760
  • Fax:
Mailing address:
  • Phone: 614-726-7359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: