Individual
DR. MICHAEL ALLEN BOTICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1220 MOUND AVE STE 301, RACINE, WI 53404-3350
(262) 633-3591
Mailing address
7127 OLD SPRING ST, RACINE, WI 53406-3304
(262) 456-0707
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
40910900
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40910900
—
WI
Enumeration date
08/05/2006
Last updated
07/09/2007
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