Individual
SUSAN JAYNE MICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1599 2ND AVE, CHARLESTON, WV 25387-2514
(304) 344-0586
Mailing address
1599 2ND AVE, CHARLESTON, WV 25387-2514
(304) 541-9832
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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