Healthcare Provider Details

I. General information

NPI: 1881859445
Provider Name (Legal Business Name): JANEL CICALO M.A,, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANEL CICALO M.A.CCC-SLP

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35746 HARPER AVE
CLINTON TWP MI
48035-3212
US

IV. Provider business mailing address

33353 REGAL
FRASER MI
48026-1757
US

V. Phone/Fax

Practice location:
  • Phone: 586-791-9203
  • Fax: 586-791-9204
Mailing address:
  • Phone: 586-296-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: