Provider Demographics
NPI:1619465143
Name:DICICCO, RONDA L
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:L
Last Name:DICICCO
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 1:1715 LINWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-2441
Mailing Address - Country:US
Mailing Address - Phone:330-432-6032
Mailing Address - Fax:
Practice Address - Street 1:638 TANYA AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3538
Practice Address - Country:US
Practice Address - Phone:330-832-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide