Healthcare Provider Details

I. General information

NPI: 1679657332
Provider Name (Legal Business Name): DALE E RUPPLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ERIE ST S
MASSILLON OH
44646-7976
US

IV. Provider business mailing address

30 E BROAD ST 11TH FLOOR ATTN TONYA FASONE
COLUMBUS OH
43215
US

V. Phone/Fax

Practice location:
  • Phone: 330-833-3135
  • Fax: 330-833-7327
Mailing address:
  • Phone: 614-466-9930
  • Fax: 614-644-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: