Provider Demographics
NPI:1770613853
Name:FICKAS, TESS M (MA)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:M
Last Name:FICKAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13952 OAKWOOD GLEN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-5814
Mailing Address - Country:US
Mailing Address - Phone:760-751-0502
Mailing Address - Fax:
Practice Address - Street 1:326 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4111
Practice Address - Country:US
Practice Address - Phone:760-751-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 2154231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner