Individual
JACQUELINE LEE LICKLITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
230 GEORGE ST STE 2, BECKLEY, WV 25801-2620
(304) 255-2878
Mailing address
230 GEORGE ST STE 2, BECKLEY, WV 25801-2620
(304) 255-2878
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2950
WV
208000000X
Pediatrics Physician
34.012256
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053671669
—
WV
Enumeration date
05/17/2012
Last updated
03/30/2026
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