Provider Demographics
NPI:1164263117
Name:MANION, KEAGAN CLAIRE (LSW)
Entity type:Individual
Prefix:
First Name:KEAGAN
Middle Name:CLAIRE
Last Name:MANION
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 N HIGH ST STE 155
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1409
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:
Practice Address - Street 1:8351 N HIGH ST STE 155
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1409
Practice Address - Country:US
Practice Address - Phone:614-664-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP-000808717104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker