Healthcare Provider Details

I. General information

NPI: 1003884743
Provider Name (Legal Business Name): ALAN DALE GILBERTSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

V. Phone/Fax

Practice location:
  • Phone: 330-344-6525
  • Fax: 330-996-2943
Mailing address:
  • Phone: 330-344-6525
  • Fax: 330-996-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number3183
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: