Provider Demographics
NPI:1780172627
Name:GILLMAN, ELIZABETH G (LSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:G
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-0722
Mailing Address - Country:US
Mailing Address - Phone:419-562-2400
Mailing Address - Fax:419-617-3771
Practice Address - Street 1:2999 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4030
Practice Address - Country:US
Practice Address - Phone:419-562-2400
Practice Address - Fax:419-617-3771
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00249451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.0024945OtherCOUNSELOR, SOCIAL WORKER & FAMILY THERAPIST BOARD