Provider Demographics
NPI:1588016224
Name:SICZKOWYCZ, JESSICA M (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:SICZKOWYCZ
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1670 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4071
Mailing Address - Country:US
Mailing Address - Phone:262-903-3912
Mailing Address - Fax:
Practice Address - Street 1:N1670 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4071
Practice Address - Country:US
Practice Address - Phone:262-903-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife