Stephanie Purdom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1901523 Issued in OH

Practice address

4625 Morse Rd Ste 200
Gahanna, OH 43230-8355

Phone

(614) 383-8381

Fax

(855) 259-2615

NPI assigned

Sep 5, 2016

Last updated

Jun 18, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wild Hope Therapy, LLC

  • Clinical Social Worker
  • Upper Arlngtn, OH
  • NPI 1386253003
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1639626914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 MORSE RD STE 200",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432308355",
            "telephone_number": "630-404-7833",
            "fax_number": "855-259-2615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4625 MORSE RD STE 200",
            "city": "GAHANNA",
            "state": "OH",
            "postal_code": "432308355",
            "telephone_number": "614-383-8381",
            "fax_number": "855-259-2615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURDOM",
        "first_name": "STEPHANIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-05",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018746",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1901523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proscan Imaging Gahanna, LLC (Proscan Imaging Gahanna)
• Proscan Radiology, LLC (ProScan Imaging Gahanna)
• Providence Home Health Care Services LLC
• PRX Pro Professional Group
• Rory Eli Puckett, PHARMD
• Pure Healthcare Service LLC
• Purpose Healthcare LLC
• Scott D Puthoff, LPN
• Quality Homecare Options
• Queenspace Counseling and Wellness, LLC

• Clinical Social Worker in Gahanna, OH
• Providers in Gahanna, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.

Verify at the official NPI Registry.