Provider Demographics
NPI:1417363805
Name:VIDIC, JANICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:VIDIC
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 1:3971 HOOVER RD
Mailing Address - Street 2:#75
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2839
Mailing Address - Country:US
Mailing Address - Phone:614-517-4586
Mailing Address - Fax:
Practice Address - Street 1:2200 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1297
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical