Healthcare Provider Details

I. General information

NPI: 1538074034
Provider Name (Legal Business Name): MARLIYATOU BAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLIY BAH

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 TAYLOR RD SW
REYNOLDSBURG OH
43068-9630
US

IV. Provider business mailing address

1555 GRAHAM RD
REYNOLDSBURG OH
43068-2632
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-1078
  • Fax:
Mailing address:
  • Phone: 614-501-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.03242
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: