=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518589886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRY SCHANTZ-HELD MSW, LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2020
-----------------------------------------------------
Last Update Date | 05/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 167 S STATE ST STE 50
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-545-8453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 GATEHOUSE LN
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43235-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-377-5509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S.1903577
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------