Provider Demographics
NPI:1013153915
Name:FICK, CHERYL J
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:J
Last Name:FICK
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 1:14235 DAVENPORT CT
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4174
Mailing Address - Country:US
Mailing Address - Phone:651-423-3569
Mailing Address - Fax:
Practice Address - Street 1:5695 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1226
Practice Address - Country:US
Practice Address - Phone:651-554-9940
Practice Address - Fax:651-554-9941
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist