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Individual
KELLY A VANSICKLE
Active
Individual
KELLY A VANSICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
S.0901492
OH
1041C0700X
Clinical Social Worker
Primary
I.1303572-SUPV
OH
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
02/14/2012
Last updated
02/24/2021
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