Healthcare Provider Details

I. General information

NPI: 1972825131
Provider Name (Legal Business Name): SHERRY LYNN GIBSON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CENTER RD STE 740
BEDFORD OH
44146-2706
US

IV. Provider business mailing address

121 CENTER RD
BEDFORD OH
44146-2706
US

V. Phone/Fax

Practice location:
  • Phone: 216-780-3555
  • Fax:
Mailing address:
  • Phone: 216-780-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1000003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: