Provider Demographics
NPI:1396477089
Name:EDWARDS-UGIOMOH, RUDESTA (MSW, LISW, LSCSW)
Entity type:Individual
Prefix:
First Name:RUDESTA
Middle Name:
Last Name:EDWARDS-UGIOMOH
Suffix:
Gender:F
Credentials:MSW, LISW, LSCSW
Other - Prefix:
Other - First Name:RUDIE
Other - Middle Name:
Other - Last Name:EDWARDS-UGIOMOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LISW, LSCSW
Mailing Address - Street 1:170 NORTHWOODS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:855-232-4482
Mailing Address - Fax:
Practice Address - Street 1:170 NORTHWOODS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:855-232-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2025-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC616157301041C0700X
KS068341041C0700X
VA09040189291041C0700X
OHI.25066661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1396477089Medicaid