Provider Demographics
NPI:1629821335
Name:GIPSON, HARRY
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:GIPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7222 GLENSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5930
Mailing Address - Country:US
Mailing Address - Phone:216-407-3900
Mailing Address - Fax:
Practice Address - Street 1:7222 GLENSHIRE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-5930
Practice Address - Country:US
Practice Address - Phone:216-407-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRF618369171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator