Healthcare Provider Details

I. General information

NPI: 1225974041
Provider Name (Legal Business Name): LEAH KICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 BAKERTOWN RD
SULLIVAN WI
53178-9769
US

IV. Provider business mailing address

206 S TAFT AVE
JEFFERSON WI
53549-1453
US

V. Phone/Fax

Practice location:
  • Phone: 920-675-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: