Provider Demographics
NPI:1225130115
Name:LALICKER, SUSAN E (ATC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LALICKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 MESA COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4902
Mailing Address - Country:US
Mailing Address - Phone:619-388-2421
Mailing Address - Fax:
Practice Address - Street 1:7250 MESA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4902
Practice Address - Country:US
Practice Address - Phone:619-388-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer