Individual
SCOTT JOSEPH CICCIARELLI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
(309) 693-3197
Mailing address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
(309) 693-3197
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085008908
IL
Other
Enumeration date
01/11/2021
Last updated
06/13/2022
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