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General NPI Number Information
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NPI Number | 1720510589
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Entity Type | Individual
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Provider Name | LAYLA MELISSA ZICKEFOOSE LCSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 130 W WENGER RD STE B
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2761
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Country | US
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Telephone | 937-886-4894
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Fax | 937-518-7787
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Provider Business Mailing Address
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Address Line | PO BOX 106
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City | BROOKVILLE
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State | OH
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Zip | 45309-0106
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Country | US
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Telephone | 937-886-4894
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Fax | 937-518-7787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009783
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License Number State | VA
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