Provider Demographics
NPI:1821049503
Name:DENNICK-REAM, ALICIA M (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:DENNICK-REAM
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17759 BLAZING STAR DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-7631
Mailing Address - Country:US
Mailing Address - Phone:440-638-4694
Mailing Address - Fax:
Practice Address - Street 1:4710 STATE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5245
Practice Address - Country:US
Practice Address - Phone:216-459-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 7957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist