Healthcare Provider Details

I. General information

NPI: 1699492199
Provider Name (Legal Business Name): JILL GILGENBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 HARDING HWY
LIMA OH
45804-3408
US

IV. Provider business mailing address

2895 HARDING HWY STE B
LIMA OH
45804-3464
US

V. Phone/Fax

Practice location:
  • Phone: 260-632-2059
  • Fax:
Mailing address:
  • Phone: 419-352-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: