Provider Demographics
NPI:1336983386
Name:LICK, CLARA
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:LICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-4370
Mailing Address - Country:US
Mailing Address - Phone:231-676-1445
Mailing Address - Fax:
Practice Address - Street 1:1915 HOWARD RD
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5163
Practice Address - Country:US
Practice Address - Phone:559-330-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician