Individual
BRENDA K STICKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 E CHESTNUT ST, WAUSEON, OH 43567-1463
(419) 357-9292
Mailing address
610 E CHESTNUT ST, WAUSEON, OH 43567-1463
(419) 357-9292
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
2695463
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180383
—
OH
05
—
2695463
—
OH
Enumeration date
11/22/2020
Last updated
11/22/2020
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