Kathleen A Ellickson, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4079 Issued in OH

Practice address

1670 Upham Dr
Columbus, OH 43210-1250

Phone

(614) 293-9600

Fax

(614) 293-8552

NPI assigned

Mar 8, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962533141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 UPHAM DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101250",
            "telephone_number": "614-293-9600",
            "fax_number": "614-293-8552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 UPHAM DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101250",
            "telephone_number": "614-293-9600",
            "fax_number": "614-293-8552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLICKSON",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "4079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4079",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alex David Ellerhorst, DO
• Simone Sheree Ellerson
• Ameya Elleston
• Haley M Ellett, CPNP-PC
• Ellice Park LLC Dba Counseling Care Circle
• Pamela S Ellinger-Dixon, PH.D.
• Mitchell Ellinger, MS, RN, CPNP
• Hannah Ellingson
• David M. Elliot, APRN-CRNA
• Alizabeth Elliott, RA

• Clinical Psychologist in Columbus, OH
• Providers in Columbus, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.