Healthcare Provider Details

I. General information

NPI: 1023463080
Provider Name (Legal Business Name): JONI KRZYCKI PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W WILSON BRIDGE RD SUITE 240
WORTHINGTON OH
43085-2238
US

IV. Provider business mailing address

500 W WILSON BRIDGE RD SUITE 240
WORTHINGTON OH
43085-2238
US

V. Phone/Fax

Practice location:
  • Phone: 614-619-2259
  • Fax: 614-847-9322
Mailing address:
  • Phone: 614-619-2259
  • Fax: 614-847-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6321
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-7530
License Number StateOH

VIII. Authorized Official

Name: DR. JONI L KRZYCKI
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 614-619-2259