Individual
JENNIFER LICKTEIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
788 8TH AVE SE, CEDAR RAPIDS, IA 52401-2119
(319) 362-1551
Mailing address
PO BOX 1824, CEDAR RAPIDS, IA 52406-1824
(319) 369-4505
(319) 369-4677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34237
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4213900
—
IA
Enumeration date
03/23/2006
Last updated
10/25/2007
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