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General NPI Number Information
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NPI Number | 1104343375
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Entity Type | Individual
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Provider Name | AYANNIA MOHAMMAD KEENER BSW-LSW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 1455 S 4TH ST
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City | COLUMBUS
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State | OH
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Zip | 43207-1011
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Country | US
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Telephone | 614-732-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 372 LAWRENCE AVE
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City | COLUMBUS
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State | OH
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Zip | 43228-6104
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Country | US
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Telephone | 614-312-2926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 1700408
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License Number State | OH
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