| Doctor Name: | MRS. FAWN CICHOSKI |
| NPI Number: | 1912305459 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | 300 68th St Se Grand Rapids, MI - 495486927 |
| Business Phone Number: | 6162224501 |
| Business Fax Number: | 6165595893 |
| Mailing Address: | 300 68th St Se, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495486927 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2014 |
| NPI Last Update Date: | 03/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |