Healthcare Provider Details

I. General information

NPI: 1043541675
Provider Name (Legal Business Name): DANIELLE ROSE FICEK-LUEBKE M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 19TH ST N
WAHPETON ND
58075-3222
US

IV. Provider business mailing address

1827 19TH ST N
WAHPETON ND
58075-3222
US

V. Phone/Fax

Practice location:
  • Phone: 701-200-1230
  • Fax:
Mailing address:
  • Phone: 701-200-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number645-11-1-09
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: