Provider Demographics
NPI:1538634902
Name:FICKER, ELIZABETH DYAN (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DYAN
Last Name:FICKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE STUCKI AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7107
Mailing Address - Country:US
Mailing Address - Phone:503-869-8108
Mailing Address - Fax:
Practice Address - Street 1:3000 NE STUCKI AVE STE 230
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7328
Practice Address - Country:US
Practice Address - Phone:503-869-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5458101YP2500X
ORC6347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR27-5551886OtherAETNA, MODA