Healthcare Provider Details

I. General information

NPI: 1033590641
Provider Name (Legal Business Name): AVALON ESPINOZA MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVALON KLEPPER MSW, LISW-S

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W WILSON BRIDGE RD STE 75
WORTHINGTON OH
43085-2238
US

IV. Provider business mailing address

233 S OHIO AVE
COLUMBUS OH
43205-1335
US

V. Phone/Fax

Practice location:
  • Phone: 614-395-9767
  • Fax:
Mailing address:
  • Phone: 614-395-9183
  • Fax: 844-333-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI.0006091-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0006091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: