Provider Demographics
NPI:1992922074
Name:HITZHUSEN, ANNA L (MSW, LISW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:HITZHUSEN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 HAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-3420
Mailing Address - Country:US
Mailing Address - Phone:614-457-4786
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGH ST STE E
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4044
Practice Address - Country:US
Practice Address - Phone:614-361-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI - 00060271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW07791Medicare ID - Type Unspecified