Healthcare Provider Details

I. General information

NPI: 1649192006
Provider Name (Legal Business Name): GILLI-ANN MARX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 LOVERS LN
RAVENNA OH
44266-4200
US

IV. Provider business mailing address

5982 RHODES RD
KENT OH
44240-8100
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-1347
  • Fax: 330-676-3677
Mailing address:
  • Phone: 330-673-1347
  • Fax: 330-676-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1450625
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: