Healthcare Provider Details

I. General information

NPI: 1801712757
Provider Name (Legal Business Name): CALIKAY VASHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 MEMORIAL DR STE 213
GREEN BAY WI
54303-6335
US

IV. Provider business mailing address

2151 SHADY LN
GREEN BAY WI
54313-9369
US

V. Phone/Fax

Practice location:
  • Phone: 920-633-3515
  • Fax:
Mailing address:
  • Phone: 920-396-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9087226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: