Individual
MS. KATHLEEN A ELLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1670 UPHAM DR, COLUMBUS, OH 43210-1250
(614) 293-9600
(614) 293-8552
Mailing address
1670 UPHAM DR, COLUMBUS, OH 43210-1250
(614) 293-9600
(614) 293-8552
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4079
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4079
LICENSE
OH
Enumeration date
03/08/2007
Last updated
07/08/2007
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