Provider Demographics
NPI:1841170552
Name:HASTRICH, KORI ELIZABETH (CDCA)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:ELIZABETH
Last Name:HASTRICH
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:ELIZABETH
Other - Last Name:DAVIS-POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1243 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1404
Mailing Address - Country:US
Mailing Address - Phone:614-321-7856
Mailing Address - Fax:
Practice Address - Street 1:1243 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1404
Practice Address - Country:US
Practice Address - Phone:614-321-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.189678207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine