Provider Demographics
NPI:1154763779
Name:RUPP, BETHANY M (LSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:M
Last Name:RUPP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22897 US HIGHWAY 20A
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-9138
Mailing Address - Country:US
Mailing Address - Phone:419-445-1980
Mailing Address - Fax:
Practice Address - Street 1:22897 US HIGHWAY 20A
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-9138
Practice Address - Country:US
Practice Address - Phone:419-445-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1302893104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker