Provider Demographics
NPI:1457199234
Name:ZICKEFOOSE, SHEILA (MA SPED, IMH-E)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:ZICKEFOOSE
Suffix:
Gender:F
Credentials:MA SPED, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2309
Mailing Address - Country:US
Mailing Address - Phone:304-613-8630
Mailing Address - Fax:
Practice Address - Street 1:205 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2309
Practice Address - Country:US
Practice Address - Phone:304-613-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency