Provider Demographics
NPI:1326438680
Name:GADSDEN, DORETHEA
Entity Type:Individual
Prefix:
First Name:DORETHEA
Middle Name:
Last Name:GADSDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORETHEA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2302
Mailing Address - Country:US
Mailing Address - Phone:330-546-8459
Mailing Address - Fax:
Practice Address - Street 1:910 8TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2302
Practice Address - Country:US
Practice Address - Phone:330-546-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH501077620206251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health