Healthcare Provider Details

I. General information

NPI: 1205247087
Provider Name (Legal Business Name): MICHELLE GEBHART LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N BARRON ST STE B
EATON OH
45320-1765
US

IV. Provider business mailing address

204 N. BARRON ST. SUITE B P.O. BOX 750
EATON OH
45320-0750
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-2805
  • Fax: 937-456-2805
Mailing address:
  • Phone: 937-456-2805
  • Fax: 937-456-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI10086-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: