Provider Demographics
NPI:1164777280
Name:KACIC, DEBORAH (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KACIC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 LANCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7521
Mailing Address - Country:US
Mailing Address - Phone:330-635-7026
Mailing Address - Fax:
Practice Address - Street 1:750 E WASHINGTON ST
Practice Address - Street 2:SUITE A6
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2196
Practice Address - Country:US
Practice Address - Phone:330-721-9357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula