Provider Demographics
NPI:1558853184
Name:GIBSON, RHONDA LYNN
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FERN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3546
Mailing Address - Country:US
Mailing Address - Phone:740-345-6246
Mailing Address - Fax:
Practice Address - Street 1:112 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5335
Practice Address - Country:US
Practice Address - Phone:740-345-6246
Practice Address - Fax:740-345-3697
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist