Provider Demographics
NPI:1215633615
Name:STICKEL, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:STICKEL
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 1:724 S BELLE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2250
Mailing Address - Country:US
Mailing Address - Phone:330-787-4708
Mailing Address - Fax:
Practice Address - Street 1:4300 BELMONT AVE STE 2
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1084
Practice Address - Country:US
Practice Address - Phone:330-759-9907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH237700000X
OH03474237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist