Healthcare Provider Details

I. General information

NPI: 1568701191
Provider Name (Legal Business Name): GIDGET L RUPERT CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 NORTHWEST BLVD STE 140
COLUMBUS OH
43212-1637
US

IV. Provider business mailing address

2458 STETZER ROAD
BUCYRUS OH
44820
US

V. Phone/Fax

Practice location:
  • Phone: 617-741-5862
  • Fax:
Mailing address:
  • Phone: 419-562-2000
  • Fax: 419-562-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1100432-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: