1023470580 NPI number — JOHN A ROFLOW LPCC

Table of content: JOHN A ROFLOW LPCC (NPI 1023470580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023470580 NPI number — JOHN A ROFLOW LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROFLOW
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023470580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1251 NILLES RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-7206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-939-0300
Provider Business Mailing Address Fax Number:
513-939-0310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 NILLES RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-939-0300
Provider Business Practice Location Address Fax Number:
513-939-0310
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E.1901255 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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