Provider Demographics
NPI:1508181280
Name:CICHON, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CICHON
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:PO BOX 350446
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33335-0446
Mailing Address - Country:US
Mailing Address - Phone:954-765-0550
Mailing Address - Fax:954-765-0587
Practice Address - Street 1:1100 W STATE ROAD 84
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2436
Practice Address - Country:US
Practice Address - Phone:954-765-0550
Practice Address - Fax:954-765-0587
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator