Healthcare Provider Details

I. General information

NPI: 1407505449
Provider Name (Legal Business Name): WENDY SUE FICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W GOOD AVE
WADSWORTH OH
44281-1636
US

IV. Provider business mailing address

212 W GOOD AVE
WADSWORTH OH
44281-1636
US

V. Phone/Fax

Practice location:
  • Phone: 330-221-4796
  • Fax:
Mailing address:
  • Phone: 330-221-4796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: