Provider Demographics
NPI:1689686925
Name:GIBSON, RULON OWEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RULON
Middle Name:OWEN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25W140 SETAUKET AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3409
Mailing Address - Country:US
Mailing Address - Phone:630-357-3013
Mailing Address - Fax:
Practice Address - Street 1:25W140 SETAUKET AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3409
Practice Address - Country:US
Practice Address - Phone:630-357-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071001666103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical