Provider Demographics
NPI:1093268864
Name:BLOCK, CADY K (PHD)
Entity Type:Individual
Prefix:
First Name:CADY
Middle Name:K
Last Name:BLOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 UPHAM DRIVE
Mailing Address - Street 2:STE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-685-5623
Mailing Address - Fax:614-293-4200
Practice Address - Street 1:1670 UPHAM DRIVE
Practice Address - Street 2:STE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-685-5623
Practice Address - Fax:614-293-4200
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH7453103G00000X
AL2002103G00000X
GAPSY004357103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist