Healthcare Provider Details

I. General information

NPI: 1336462241
Provider Name (Legal Business Name): KAREN ANN JICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 N FARWELL AVE
MILWAUKEE WI
53202-2329
US

IV. Provider business mailing address

N80W13385 RIVER PARK DR
MENOMONEE FALLS WI
53051-3990
US

V. Phone/Fax

Practice location:
  • Phone: 414-273-2220
  • Fax:
Mailing address:
  • Phone: 414-217-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number562-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number562-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: