Provider Demographics
NPI:1558151811
Name:TASICH, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:TASICH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BRYDEN RD. STE 122
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-681-0012
Mailing Address - Fax:614-412-6944
Practice Address - Street 1:700 BRYDEN RD. STE 122
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-681-0012
Practice Address - Fax:614-412-6944
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health