Healthcare Provider Details

I. General information

NPI: 1093722795
Provider Name (Legal Business Name): BARBARA A CICHOLSKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 HEAVILON HALL 500 OVAL DRIVE
WEST LAFAYETTE IN
47907-2038
US

IV. Provider business mailing address

601 STADIUM MALL DRIVE
WEST LAFAYETTE IN
47907-2052
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-3792
  • Fax: 765-494-0771
Mailing address:
  • Phone: 765-496-1927
  • Fax: 764-496-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22002927A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: