Provider Demographics
NPI:1851742597
Name:KELLY ROTHERT, LISW, LLC
Entity Type:Organization
Organization Name:KELLY ROTHERT, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-9560
Mailing Address - Street 1:4041 N HIGH ST
Mailing Address - Street 2:SUITE 402A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3253
Mailing Address - Country:US
Mailing Address - Phone:614-787-5565
Mailing Address - Fax:844-335-1293
Practice Address - Street 1:4041 N HIGH ST
Practice Address - Street 2:SUITE 402A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3253
Practice Address - Country:US
Practice Address - Phone:614-787-5565
Practice Address - Fax:844-335-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15023551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty