Basic Information
| Provider Information | |||||||||
| NPI: | 1811365166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIPLE | ||||||||
| FirstName: | REBECCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 GRAPHICS WAY | ||||||||
| Address2: | |||||||||
| City: | LEWIS CENTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430351122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404280428 | ||||||||
| FaxNumber: | 7409094077 | ||||||||
| Practice Location | |||||||||
| Address1: | 2932 S 3 BS AND K RD | ||||||||
| Address2: | |||||||||
| City: | GALENA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430218545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149757615 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1600270 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 2846675 | 05 | OH | MEDICAID |