Provider Demographics
NPI:1669760120
Name:CICHOSZ, TODD J (PA-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:CICHOSZ
Suffix:
Gender:M
Credentials:PA-C
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 1183
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-1183
Mailing Address - Country:US
Mailing Address - Phone:360-723-0528
Mailing Address - Fax:
Practice Address - Street 1:101 NW 12TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9141
Practice Address - Country:US
Practice Address - Phone:360-723-0528
Practice Address - Fax:360-995-0081
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006041363A00000X
ORMC2783290363AM0700X
WAMC3397886363AM0700X
WAPA60470619363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant