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General NPI Number Information
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NPI Number | 1063423762
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Entity Type | Organization
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Legal Business Name | WYNSERVE, INC.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2939 KENNY RD SUITE 180
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City | COLUMBUS
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State | OH
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Zip | 43221-2406
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Country | US
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Telephone | 614-326-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 CLUBVIEW BLVD N
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City | COLUMBUS
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State | OH
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Zip | 43235-1222
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Country | US
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Telephone | 614-433-7374
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROXANNE CROCCO
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Credential | LISW
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Telephone | 614-433-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I26803
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License Number State | OH
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