Healthcare Provider Details

I. General information

NPI: 1871616979
Provider Name (Legal Business Name): JAMES MICHAEL FICO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BOWLING LN
WAUPACA WI
54981-7707
US

IV. Provider business mailing address

750 BOWLING LN
WAUPACA WI
54981-7707
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-8080
  • Fax: 715-258-8712
Mailing address:
  • Phone: 715-258-8080
  • Fax: 715-258-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number626
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: