Provider Demographics
NPI:1275682197
Name:FICKARDT, CASEY E (ASW)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:E
Last Name:FICKARDT
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 SHADOWBROOK WAY #9
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969
Mailing Address - Country:US
Mailing Address - Phone:530-877-5623
Mailing Address - Fax:530-895-6549
Practice Address - Street 1:1090 SHADOWBROOK WAY #9
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969
Practice Address - Country:US
Practice Address - Phone:530-877-5623
Practice Address - Fax:530-895-6549
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW #20409OtherBOARD OF BEHAVIORAL SCIEN