Provider Demographics
NPI:1235469339
Name:LISICK, KAY ELIZABETH (MSW, CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:ELIZABETH
Last Name:LISICK
Suffix:
Gender:F
Credentials:MSW, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 28TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7612
Mailing Address - Country:US
Mailing Address - Phone:608-780-8342
Mailing Address - Fax:
Practice Address - Street 1:3152 28TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7612
Practice Address - Country:US
Practice Address - Phone:608-780-8342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15379-132101YA0400X
WI8422-123101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100007373Medicaid