Provider Demographics
NPI:1013190743
Name:LICHLITER, ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LICHLITER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:601 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3822
Practice Address - Country:US
Practice Address - Phone:507-453-9563
Practice Address - Fax:507-453-9562
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN185291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33P33LIOtherBCBS-MN
MN876638100Medicaid
MN876638100Medicaid