Individual
JUSTIN JICKESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5333 MCAULEY DRIVE, SUITE 2115, YPSILANTI, MI 48197-8633
(734) 712-3971
Mailing address
500 E REGENCY CIR, CANFIELD, OH 44406-9643
(330) 502-5005
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
03/29/2023
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