Provider Demographics
NPI:1588128185
Name:KUICK, KYLE ROBERT
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:KUICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 N TEUTONIA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1550
Mailing Address - Country:US
Mailing Address - Phone:262-289-3274
Mailing Address - Fax:920-243-2060
Practice Address - Street 1:8330 N TEUTONIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1550
Practice Address - Country:US
Practice Address - Phone:262-289-3274
Practice Address - Fax:920-243-2060
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician