Provider Demographics
NPI:1174121214
Name:OSWALT, ANDREW CLARK (MDIV)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CLARK
Last Name:OSWALT
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 OAKLAND PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4119
Mailing Address - Country:US
Mailing Address - Phone:614-668-2332
Mailing Address - Fax:
Practice Address - Street 1:45 OAKLAND PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4119
Practice Address - Country:US
Practice Address - Phone:614-668-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral