Provider Demographics
NPI:1063649390
Name:WARGO, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WARGO
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 1:20 N GRAND AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1755
Mailing Address - Country:US
Mailing Address - Phone:216-468-5000
Mailing Address - Fax:216-456-8128
Practice Address - Street 1:20 N GRAND AVE STE 15
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1755
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:216-456-8128
Is Sole Proprietor?:No
Enumeration Date:2009-06-13
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283098101YP2500X
OHE.0600541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid