Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 7853 | OH |
Y | 103G00000X | Clinical Psychologist | 7853 | OH |
Y | 103TC0700X | Clinical Psychologist | 7853 | OH |
NPI | 1144862780 |
---|---|
Provider Name | Brock J Schludecker |
First Address | Columbus, OH 43202-1436 |
Second Address | Dublin, OH 43017-3239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2019 |
Last Update Date | 15/10/2019 |