MEDICARE: MR. AIDEN EDWARD DUNKLE PRS

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	175T00000X	Peer Specialist	APS.007034	OH

General Provider Information

NPI Number	:	1396608485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AIDEN EDWARD DUNKLE PRS

Provider Business Mailing Address
First Line	:	180 E TOMPKINS ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-3032
Country	:	US
Telephone Number	:	614-307-9535
Fax Number	:

Provider Business Practice Location Address
First Line	:	4998 W BROAD ST STE 104
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1647
Country	:	US
Telephone Number	:	614-754-8051
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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