Provider Demographics
NPI:1528585205
Name:GIBSON, SUSAN YVETTE (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:YVETTE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 BOWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9661
Mailing Address - Country:US
Mailing Address - Phone:740-695-7795
Mailing Address - Fax:
Practice Address - Street 1:824 BOWTOWN RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-9661
Practice Address - Country:US
Practice Address - Phone:740-695-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701745104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker