Provider Demographics
NPI:1538797063
Name:DICIOCCIO, PATRICIA LUCILLE (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LUCILLE
Last Name:DICIOCCIO
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 GATES MILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9310
Mailing Address - Country:US
Mailing Address - Phone:216-408-7441
Mailing Address - Fax:
Practice Address - Street 1:6825 GATES MILLS BLVD
Practice Address - Street 2:
Practice Address - City:GATES MILLS
Practice Address - State:OH
Practice Address - Zip Code:44040-9310
Practice Address - Country:US
Practice Address - Phone:216-408-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP00345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist