Provider Demographics
NPI:1518657329
Name:FLICK, SKYLER M
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:M
Last Name:FLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 15TH AVE S APT C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4545
Mailing Address - Country:US
Mailing Address - Phone:701-730-6848
Mailing Address - Fax:
Practice Address - Street 1:1530 1ST AVE N
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2893
Practice Address - Country:US
Practice Address - Phone:218-309-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician