Provider Demographics
NPI:1689002487
Name:MOSHER, THERESA LYNN MIHALIC (MS, LGC)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNN MIHALIC
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:MIHALIC MOSHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LGC
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:TIMKEN HALL 235
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2478
Mailing Address - Fax:614-722-3546
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:TIMKEN HALL 235
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-2478
Practice Address - Fax:614-722-3546
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70.000062170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS