Active NPI
Brock J Schludecker
- Clinical Psychologist
- Dublin, OH
National Provider Identifier
1144862780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7853
- Practice address
- 6631 Commerce Pkwy Ste R
Dublin, OH 43017-3239 - Phone
- (614) 360-2600
- NPI assigned
- Oct 15, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 7853 | OH | |
| Clinical Psychologist | 103TC0700X | 7853 | OH | Primary |
Addresses
Primary practice location
6631 Commerce Pkwy Ste R
Dublin, OH 43017-3239
Mailing address
120 Tibet Rd
Columbus, OH 43202-1436
Phone (330) 464-5573
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 |
|---|---|---|---|
| 7853 | OH | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571097600000",
"number": "1144862780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 TIBET RD",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432021436",
"telephone_number": "330-464-5573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6631 COMMERCE PKWY STE R",
"city": "DUBLIN",
"state": "OH",
"postal_code": "430173239",
"telephone_number": "614-360-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHLUDECKER",
"first_name": "BROCK",
"middle_name": "J",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-15",
"last_updated": "2019-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "7853",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "7853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.