Provider Demographics
NPI:1558856955
Name:GIBSON, LEIGHANNE I (QBHS)
Entity Type:Individual
Prefix:MS
First Name:LEIGHANNE
Middle Name:
Last Name:GIBSON
Suffix:I
Gender:F
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-1025
Mailing Address - Country:US
Mailing Address - Phone:419-304-8086
Mailing Address - Fax:
Practice Address - Street 1:624 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1777
Practice Address - Country:US
Practice Address - Phone:419-720-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator