MEDICARE: MS. KATHY ILENE ALDEN

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	172A00000X	Driver	2624664	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2530452	OTHER	OH	ODMRDD CONTRACT NUMBER

General Provider Information

NPI Number	:	1679793681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY ILENE ALDEN

Provider Business Mailing Address
First Line	:	1865 UPPER CHELSEA RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1939
Country	:	US
Telephone Number	:	614-477-5720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 UPPER CHELSEA RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1939
Country	:	US
Telephone Number	:	614-477-5720
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/13/2012

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