Provider Demographics
NPI:1104493964
Name:REDMON, JOHNATHON W (LISW)
Entity type:Individual
Prefix:MR
First Name:JOHNATHON
Middle Name:W
Last Name:REDMON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 BRIDGEWAY CIR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3314
Mailing Address - Country:US
Mailing Address - Phone:567-204-5234
Mailing Address - Fax:
Practice Address - Street 1:810 FOX RUN RD APT E
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7490
Practice Address - Country:US
Practice Address - Phone:567-204-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.24051971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical