Provider Demographics
NPI:1245647858
Name:ZICCHINELLI, OLIVIA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ZICCHINELLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:O.C. ZICCHINELLI
Other - Middle Name:
Other - Last Name:DBA SUPER-KIDS INTERACTIVE INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6503 WINFIELD BLVD # 223D
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6503 WINFIELD BLVD # 223D
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7169
Practice Address - Country:US
Practice Address - Phone:954-254-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist