Provider Demographics
NPI:1902451164
Name:WEATHERSPOON, ROKIA (EDS)
Entity type:Individual
Prefix:
First Name:ROKIA
Middle Name:
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ROKIA
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:540 OFFICENTER PL STE 160
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5351
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:
Practice Address - Street 1:2177 MOCK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1258
Practice Address - Country:US
Practice Address - Phone:567-312-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH270700103TS0200X
OH21174760103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool