Healthcare Provider Details

I. General information

NPI: 1598451940
Provider Name (Legal Business Name): KATIE FICKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 KRAYS MILL RD
COLD SPRING MN
56320-4563
US

IV. Provider business mailing address

17586 JANSSEN DR
COLD SPRING MN
56320-8802
US

V. Phone/Fax

Practice location:
  • Phone: 320-348-1250
  • Fax:
Mailing address:
  • Phone: 320-492-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24195
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: