Healthcare Provider Details

I. General information

NPI: 1174061824
Provider Name (Legal Business Name): REBECCA ELKINS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22251 STATE ROUTE 2
ARCHBOLD OH
43502-9452
US

IV. Provider business mailing address

22251 STATE ROUTE 2
ARCHBOLD OH
43502-9452
US

V. Phone/Fax

Practice location:
  • Phone: 419-438-5541
  • Fax:
Mailing address:
  • Phone: 419-445-1552
  • Fax: 419-445-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0005340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: