Healthcare Provider Details

I. General information

NPI: 1619088317
Provider Name (Legal Business Name): KATHLEEN CONNELL PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6827 N HIGH ST SUITE 232
WORTHINGTON OH
43085-2517
US

IV. Provider business mailing address

6827 N HIGH ST SUITE 232
WORTHINGTON OH
43085-2517
US

V. Phone/Fax

Practice location:
  • Phone: 614-504-5580
  • Fax: 614-436-1800
Mailing address:
  • Phone: 614-504-5580
  • Fax: 614-436-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500723
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: