Active NPI
Marie Holmes Desloge, ACSW
- Clinical Social Worker
- Columbus, OH
National Provider Identifier
1083997589
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.1700033
- Practice address
- 399 E Main St
Columbus, OH 43215-5384 - Phone
- (614) 355-8550
- Fax
- (614) 355-8593
- NPI assigned
- Sep 21, 2011
- Last updated
- Jul 21, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 60021 | CA | |
| Clinical Social Worker | 1041C0700X | I.1700033 | OH | Primary |
Addresses
Primary practice location
399 E Main St
Columbus, OH 43215-5384
Mailing address
Dept 781625
Detroit, MI 48278-1625
Phone (614) 355-8004
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0211467 | Medicaid | OH | |
| 2846675 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60021 | CA | MD | Mental Health Counselor |
| I.1700033 | OH | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nationwide Children's Hospital | Past | Accepting new patients | |
| Nationwide Children's Hospital | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Columbus, OH
- NPI 1407013964
-
- Multi-Specialty Clinic/Center
- Columbus, OH
- NPI 1851179873
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500595200000",
"number": "1083997589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DEPT 781625",
"city": "DETROIT",
"state": "MI",
"postal_code": "482781625",
"telephone_number": "614-355-8004",
"fax_number": "614-355-2220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "399 E MAIN ST",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432155384",
"telephone_number": "614-355-8550",
"fax_number": "614-355-8593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESLOGE",
"first_name": "MARIE",
"middle_name": "HOLMES",
"credential": "ACSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-21",
"last_updated": "2017-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "60021",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.1700033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0211467",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2846675",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.