Individual
SHAYDE FICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 ROYAL ST STE D, KELSO, WA 98626-1167
(360) 423-1509
Mailing address
724 3RD AVE SW, CASTLE ROCK, WA 98611-8113
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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