Provider Demographics
NPI:1558846600
Name:FICKER, KELSEE JO
Entity Type:Individual
Prefix:
First Name:KELSEE
Middle Name:JO
Last Name:FICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEE
Other - Middle Name:JO
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:492 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-4922
Mailing Address - Country:US
Mailing Address - Phone:307-677-3369
Mailing Address - Fax:
Practice Address - Street 1:350 CITY VIEW DR STE 206
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5326
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:307-789-6009
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator