Basic Information
| Provider Information | |||||||||
| NPI: | 1801371547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALDEN | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143554507 | ||||||||
| FaxNumber: | 6143554497 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 BUTTERFLY GARDENS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432153427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558695 | ||||||||
| FaxNumber: | 6143557855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 104100000X | S.2005227 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.