Healthcare Provider Details

I. General information

NPI: 1770341570
Provider Name (Legal Business Name): DELECIA MICHELLE NORWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR NW
CANTON OH
44718-2384
US

IV. Provider business mailing address

3222 S ABERDEEN ST CHICAGO, IL 60608 APT 3FFB
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax: 330-433-1843
Mailing address:
  • Phone: 815-549-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: