Healthcare Provider Details

I. General information

NPI: 1063649390
Provider Name (Legal Business Name): CHERYL WARGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N GRAND AVE STE 15
FORT THOMAS KY
41075-1755
US

IV. Provider business mailing address

20 N GRAND AVE STE 15
FORT THOMAS KY
41075-1755
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax: 216-456-8128
Mailing address:
  • Phone: 216-468-5000
  • Fax: 216-456-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number283098
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0600541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: