Provider Demographics
NPI:1518740653
Name:KANU, EJARTU (R-SWA)
Entity Type:Individual
Prefix:
First Name:EJARTU
Middle Name:
Last Name:KANU
Suffix:
Gender:F
Credentials:R-SWA
Other - Prefix:MS
Other - First Name:EJARTU
Other - Middle Name:
Other - Last Name:KANU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R-SWA
Mailing Address - Street 1:700 BRYDEN RD STE 122
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 BRYDEN RD STE 122
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4839
Practice Address - Country:US
Practice Address - Phone:614-681-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHW.2300361104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker