Provider Demographics
NPI:1750081618
Name:BRICKEY, DAVID WAYNE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:BRICKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 GALLIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5541
Mailing Address - Country:US
Mailing Address - Phone:740-529-7020
Mailing Address - Fax:740-529-7085
Practice Address - Street 1:4502 GALLIA ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:OH
Practice Address - Zip Code:45662-5541
Practice Address - Country:US
Practice Address - Phone:740-529-7020
Practice Address - Fax:740-529-7085
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator