Provider Demographics
NPI:1710872825
Name:RICCIONE, AVA C
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:C
Last Name:RICCIONE
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 1:1237 N VAN BUREN ST UNIT 641
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5112
Mailing Address - Country:US
Mailing Address - Phone:708-925-7892
Mailing Address - Fax:
Practice Address - Street 1:8440 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1734
Practice Address - Country:US
Practice Address - Phone:414-405-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health