Provider Demographics
NPI:1518343870
Name:GILBERT, KATIE (LISW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-0794
Mailing Address - Country:US
Mailing Address - Phone:740-963-3777
Mailing Address - Fax:614-401-4133
Practice Address - Street 1:226 BLUFF RIDGE DR
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8069
Practice Address - Country:US
Practice Address - Phone:740-963-3777
Practice Address - Fax:614-401-4133
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.13022521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223865Medicaid