Provider Demographics
NPI:1700125614
Name:HEDDEN, PHILLIP EDWARD (LSW)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:EDWARD
Last Name:HEDDEN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 ARROWOOD LOOP N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5278
Mailing Address - Country:US
Mailing Address - Phone:614-753-0741
Mailing Address - Fax:
Practice Address - Street 1:1638 ARROWOOD LOOP N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5278
Practice Address - Country:US
Practice Address - Phone:614-753-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS4014104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical