Provider Demographics
NPI:1831879170
Name:ECKLES, ANNA (LSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ECKLES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 BLYTHE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1139
Mailing Address - Country:US
Mailing Address - Phone:513-739-6810
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD STE 212C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7045
Practice Address - Country:US
Practice Address - Phone:614-437-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.22073721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical