Healthcare Provider Details

I. General information

NPI: 1336774819
Provider Name (Legal Business Name): ZIGGY CICCHELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 METRO PL N STE 100
DUBLIN OH
43017-5343
US

IV. Provider business mailing address

525 METRO PL N STE 100
DUBLIN OH
43017-5343
US

V. Phone/Fax

Practice location:
  • Phone: 855-289-1722
  • Fax:
Mailing address:
  • Phone: 855-289-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2004692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: