Provider Demographics
NPI:1336204957
Name:WOLMAN, JERILYN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERILYN
Middle Name:L
Last Name:WOLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 EAST BROAD ST.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-2012
Mailing Address - Country:US
Mailing Address - Phone:614-252-5151
Mailing Address - Fax:614-231-1378
Practice Address - Street 1:1620 E BROAD ST
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-2072
Practice Address - Country:US
Practice Address - Phone:614-252-5151
Practice Address - Fax:614-231-1378
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical