Provider Demographics
NPI:1548808017
Name:GIBBS, STACY (MSW)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2545
Mailing Address - Country:US
Mailing Address - Phone:220-203-8359
Mailing Address - Fax:
Practice Address - Street 1:844 OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2545
Practice Address - Country:US
Practice Address - Phone:220-203-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904379104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker