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General NPI Number Information
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NPI Number | 1992390512
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Entity Type | Individual
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Provider Name | CONNIE WEATHERHOLT BSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 525 METRO PL N STE 300
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City | DUBLIN
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State | OH
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Zip | 43017-5320
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Country | US
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Telephone | 855-289-1722
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 TOWNSHIP ROAD 1175
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City | ASHLAND
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State | OH
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Zip | 44805-1980
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2410322
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License Number State | OH
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