Provider Demographics
NPI:1609368760
Name:BALDAUF, RHIANNON Y (LISW)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:Y
Last Name:BALDAUF
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:RHIANNON
Other - Middle Name:
Other - Last Name:SUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5675 VENTURE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2159
Practice Address - Country:US
Practice Address - Phone:614-355-9580
Practice Address - Fax:614-355-9589
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21029361041C0700X
OHS.1802265104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid