Healthcare Provider Details

I. General information

NPI: 1023088424
Provider Name (Legal Business Name): JEFFREY CIGRANG PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE 300
LIMA OH
45801-5914
US

IV. Provider business mailing address

15310 PROVIDENCE PIKE
BROOKVILLE OH
45309-8722
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-4008
  • Fax: 419-996-4007
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number5843
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.5834
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: