MEDICARE: JUSTINE LEKEAZEM EPSE ASONGAFACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	603068840825	OH

General Provider Information

NPI Number	:	1043173081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE LEKEAZEM EPSE ASONGAFACK

Provider Business Mailing Address
First Line	:	1979 BAIRSFORD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-7001
Country	:	US
Telephone Number	:	380-264-6617
Fax Number	:

Provider Business Practice Location Address
First Line	:	1979 BAIRSFORD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-7001
Country	:	US
Telephone Number	:	380-264-6617
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	04/17/2026

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