Healthcare Provider Details

I. General information

NPI: 1780514703
Provider Name (Legal Business Name): REBECCA LEPAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2391
US

IV. Provider business mailing address

994 KENMORE XING UNIT 104
MARYSVILLE OH
43040-7176
US

V. Phone/Fax

Practice location:
  • Phone: 614-681-1030
  • Fax:
Mailing address:
  • Phone: 201-264-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: