Basic Information
| Provider Information | |||||||||
| NPI: | 1134439508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMMONS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4897 KARL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432295147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148462588 | ||||||||
| FaxNumber: | 6148469759 | ||||||||
| Practice Location | |||||||||
| Address1: | 4897 KARL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432295147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148462588 | ||||||||
| FaxNumber: | 6148469759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2010 | ||||||||
| LastUpdateDate: | 10/19/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S1000730 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.