Individual
MILDRED V KICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
213 N BLACK RIVER ST, SPARTA, WI 54656-1529
(608) 487-9990
Mailing address
MILLIE KICK, N2610 ANTONY RD, BANGOR, WI 54614-9315
(608) 486-2927
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
755-146
WI
Other
Enumeration date
10/05/2018
Last updated
10/05/2018
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