Provider Demographics
NPI:1023324308
Name:PIERSON, MANDI (LISW-S)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:PIERSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 OLENTANGY RIVER ROAD
Mailing Address - Street 2:BUILDING D, SUITE 105
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-245-5334
Mailing Address - Fax:
Practice Address - Street 1:3600 OLENTANGY RIVER ROAD
Practice Address - Street 2:BUILDING D, SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-245-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid