Healthcare Provider Details

I. General information

NPI: 1225973167
Provider Name (Legal Business Name): VICKIE DEETER CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 KECK PARK CIRCLE
NW NORTH CANTON OH
45383
US

IV. Provider business mailing address

178 EMERICK RD
WEST MILTON OH
45383-1362
US

V. Phone/Fax

Practice location:
  • Phone: 330-415-0272
  • Fax:
Mailing address:
  • Phone: 330-415-0272
  • Fax: 234-214-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: