Healthcare Provider Details

I. General information

NPI: 1790377794
Provider Name (Legal Business Name): GABRIELLE M. HODGES LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 KENWOOD BLVD APT 203
TOLEDO OH
43606-3218
US

IV. Provider business mailing address

2732 KENWOOD BLVD APT 203
TOLEDO OH
43606-3218
US

V. Phone/Fax

Practice location:
  • Phone: 567-218-3648
  • Fax:
Mailing address:
  • Phone: 567-218-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506430-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: