Individual
DYAN VANSICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DTR, IBCLC, CLC
Contact information
Practice address
1680 CLAY BANK RD, LOGAN, OH 43138-9187
(740) 603-6081
Mailing address
1680 CLAY BANK RD, LOGAN, OH 43138-9187
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
—
OH
174N00000X
Lactation Consultant (Non-RN)
Primary
—
OH
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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