Healthcare Provider Details

I. General information

NPI: 1891444881
Provider Name (Legal Business Name): KATHERINA J. VANSICKEL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 S CAPALDI DR UNIT 611
ST GEORGE UT
84770-7623
US

IV. Provider business mailing address

992 S CAPALDI DR UNIT 611
ST GEORGE UT
84770-7623
US

V. Phone/Fax

Practice location:
  • Phone: 515-509-9186
  • Fax:
Mailing address:
  • Phone: 515-509-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINA VANSICKEL
Title or Position: THERAPIST/COUNSELOR
Credential: LISW
Phone: 515-509-9186