Provider Demographics
NPI:1982326369
Name:NICK YACKOVICH, PHD, S.C.
Entity Type:Organization
Organization Name:NICK YACKOVICH, PHD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:YACKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-215-0600
Mailing Address - Street 1:2800 ROYAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1518
Mailing Address - Country:US
Mailing Address - Phone:608-215-0600
Mailing Address - Fax:608-471-4222
Practice Address - Street 1:2800 ROYAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1518
Practice Address - Country:US
Practice Address - Phone:608-471-4222
Practice Address - Fax:608-471-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)