Provider Demographics
NPI:1598451940
Name:FICKER, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FICKER
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 1:17586 JANSSEN DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-8802
Mailing Address - Country:US
Mailing Address - Phone:320-492-1164
Mailing Address - Fax:
Practice Address - Street 1:224 KRAYS MILL RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-4563
Practice Address - Country:US
Practice Address - Phone:320-348-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24195104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker