Provider Demographics
NPI:1235896168
Name:MCGUCKEN, ALISON (LISW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MCGUCKEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1416
Mailing Address - Country:US
Mailing Address - Phone:614-636-2462
Mailing Address - Fax:
Practice Address - Street 1:4041 N HIGH ST STE 300H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3200
Practice Address - Country:US
Practice Address - Phone:614-984-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.20022071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472290Medicaid