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NPI Code Detail

MEDICARE: ADRIANE LEE PECK LISW

MEDICARE: ADRIANE LEE PECK LISW
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
11041C0700XClinical Social WorkerI.1451088OH

General Provider Information

NPI Number : 1790160356
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRIANE LEE PECK LISW
Provider Business Mailing Address
First Line : 1800 WATERMARK DR
Second Line : SUITE 420
City : COLUMBUS
State : OH
Zip : 43215-1048
Country : US
Telephone Number : 614-645-5500
Fax Number : 614-645-5517
Provider Business Practice Location Address
First Line : 1905 PARSONS AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1933
Country : US
Telephone Number : 614-586-4159
Fax Number : 614-586-4252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2015
Last Update Date : 07/24/2015

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Directions to “ ADRIANE LEE PECK LISW” Practice Location

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