Healthcare Provider Details

I. General information

NPI: 1992372486
Provider Name (Legal Business Name): MRS. ADELYNN GIPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HARDING HWY
LIMA OH
45804-3433
US

IV. Provider business mailing address

2727 HARDING HWY
LIMA OH
45804-3433
US

V. Phone/Fax

Practice location:
  • Phone: 419-221-2821
  • Fax: 419-221-2824
Mailing address:
  • Phone: 419-221-2821
  • Fax: 419-221-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2004763
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: