Provider Demographics
NPI:1639573090
Name:CALHOUN, REBECCA
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2924
Mailing Address - Country:US
Mailing Address - Phone:614-260-1319
Mailing Address - Fax:
Practice Address - Street 1:2626 DOVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2924
Practice Address - Country:US
Practice Address - Phone:614-260-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090323Medicaid