Individual
COLLEEN KICKBUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9231 W MOUNT VERNON AVE, MILWAUKEE, WI 53226-4408
(224) 321-7007
Mailing address
9231 W MOUNT VERNON AVE, MILWAUKEE, WI 53226-4408
(224) 321-7007
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/07/2021
Last updated
02/07/2021
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