Basic Information
| Provider Information | |||||||||
| NPI: | 1811314321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDLE | ||||||||
| FirstName: | NIKI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSW, LISW-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 HELDMAN STREET | ||||||||
| Address2: | |||||||||
| City: | JENERA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193063503 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15100 BIRCHAVEN LANE | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235351 | ||||||||
| FaxNumber: | 4194238967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 08/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.1440141 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.