Healthcare Provider Details

I. General information

NPI: 1386128825
Provider Name (Legal Business Name): ELIZABETH GUMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTRAL CTR
CHILLICOTHEE OH
45601-2253
US

IV. Provider business mailing address

20 CENTRAL CTR
CHILLICOTHEE OH
45601-2253
US

V. Phone/Fax

Practice location:
  • Phone: 740-771-9022
  • Fax:
Mailing address:
  • Phone: 740-771-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: