Provider Demographics
NPI:1568757326
Name:GROTHAUS, JEANNE C (LSW, LPC)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:C
Last Name:GROTHAUS
Suffix:
Gender:F
Credentials:LSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DENNISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3262
Mailing Address - Country:US
Mailing Address - Phone:614-884-4400
Mailing Address - Fax:614-884-4484
Practice Address - Street 1:1100 DENNISON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3262
Practice Address - Country:US
Practice Address - Phone:614-884-4400
Practice Address - Fax:614-884-4484
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC3359101YP2500X
OHS6892104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker