Provider Demographics
NPI:1407222318
Name:ZILICH-MILLER, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ZILICH-MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9975 JACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEGLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44441-9710
Mailing Address - Country:US
Mailing Address - Phone:330-426-2889
Mailing Address - Fax:
Practice Address - Street 1:611 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1037
Practice Address - Country:US
Practice Address - Phone:330-744-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS28891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241705Medicaid