Provider Demographics
NPI:1518905710
Name:TODD, AUDREY C (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:C
Last Name:TODD
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 1:3763 N HIGH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3547
Mailing Address - Country:US
Mailing Address - Phone:614-595-7729
Mailing Address - Fax:614-447-9241
Practice Address - Street 1:3763 N HIGH ST
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3547
Practice Address - Country:US
Practice Address - Phone:614-595-7729
Practice Address - Fax:614-447-9241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical