Provider Demographics
NPI:1770061525
Name:HERTEL, GRACE HUNTER (LISW)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:HUNTER
Last Name:HERTEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:HUNTER
Other - Last Name:REA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-9600
Mailing Address - Fax:614-293-1456
Practice Address - Street 1:1800 ZOLLINGER RD FL 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2800
Practice Address - Country:US
Practice Address - Phone:614-293-9600
Practice Address - Fax:614-293-1456
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2102958104100000X
OHS.1802736104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker