Individual
KAITLYN MARIE LICCION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2145 CENTENNIAL PLZ, EUGENE, OR 97401-2474
(541) 485-6340
Mailing address
3039 BRETT LOOP, EUGENE, OR 97404-3805
(315) 317-2585
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/11/2019
Last updated
05/27/2022
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