Individual
JACQUELINE MARIA VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1575 ALLOUEZ AVE, GREEN BAY, WI 54311-5639
(507) 429-5018
Mailing address
8411 S FORK DR, CALEDONIA, MN 55921-3736
(075) 429-5018
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
309411
MN DEPT OF ED
MN
Enumeration date
04/23/2018
Last updated
03/12/2019
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