Active NPI
Stephanie Purdom, LCSW
- Clinical Social Worker
- Gahanna, OH
National Provider Identifier
1639626914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.1901523
- Practice address
- 4625 Morse Rd Ste 200
Gahanna, OH 43230-8355 - Phone
- (614) 383-8381
- Fax
- (855) 259-2615
- NPI assigned
- Sep 5, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 149018746 | IL | |
| Clinical Social Worker | 1041C0700X | I.1901523 | OH | Primary |
Addresses
Primary practice location
4625 Morse Rd Ste 200
Gahanna, OH 43230-8355
Mailing address
4625 Morse Rd Ste 200
Columbus, OH 43230-8355
Phone (630) 404-7833
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149018746 | IL | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Hope Therapy, LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
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": []
}Other providers in Gahanna, OH
Sources for this page
- 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.