Individual
NICOLE M FORNALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
480 MEDICAL CENTER DR, COLUMBUS, OH 43210-1229
(614) 293-7604
(614) 293-3809
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 293-7604
(614) 293-3809
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
P.08416
OH
103TR0400X
Rehabilitation Psychologist
P.08416
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015860
—
OH
Enumeration date
02/28/2023
Last updated
05/16/2023
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