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Individual

JOANNE KAREN ICKSTADT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
2900 CHARLEVOIX DR SE, SUITE #200, GRAND RAPIDS, MI 49546-7085
(800) 634-1077
Mailing address
860 3 CRABS RD, SEQUIM, WA 98382-7852
(719) 510-6420

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00010467
WA

Other

Enumeration date
06/25/2007
Last updated
07/08/2007
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