Provider Demographics
NPI:1801189428
Name:TUCKER, JOAN E (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 TALISMAN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3166
Mailing Address - Country:US
Mailing Address - Phone:614-237-7237
Mailing Address - Fax:614-237-7237
Practice Address - Street 1:428 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5344
Practice Address - Country:US
Practice Address - Phone:614-237-7237
Practice Address - Fax:614-237-7237
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00040361041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker