Provider Demographics
NPI:1407492655
Name:VAN SICKLE, DEANNA MARIE (MSW LSW)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:VAN SICKLE
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:MARIE
Other - Last Name:MASCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LSW
Mailing Address - Street 1:527 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5602
Mailing Address - Country:US
Mailing Address - Phone:614-487-8758
Mailing Address - Fax:
Practice Address - Street 1:527 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5602
Practice Address - Country:US
Practice Address - Phone:614-487-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker