MEDICARE: KYLIE CICCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.12009	OH

General Provider Information

NPI Number	:	1902514474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE CICCO

Provider Business Mailing Address
First Line	:	2275 COLLINGWOOD BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43620-1100
Country	:	US
Telephone Number	:	419-245-4150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 WRENWOOD RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-1762
Country	:	US
Telephone Number	:	419-671-5199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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Directions to “ KYLIE CICCO ” Practice Location

Language	Start Address	Practice Location

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