Provider Demographics
NPI:1679962971
Name:DEFRANK, ALECIA
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:DEFRANK
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 1:707 WILKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2152
Mailing Address - Country:US
Mailing Address - Phone:234-855-1662
Mailing Address - Fax:
Practice Address - Street 1:707 WILKINSON AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2152
Practice Address - Country:US
Practice Address - Phone:234-855-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0091132172V00000X
FL25770971172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091132Medicaid