Provider Demographics
NPI:1588898696
Name:KLICKER, VERONICA (LMP)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:KLICKER
Suffix:
Gender:
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 W 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2544
Mailing Address - Country:US
Mailing Address - Phone:509-301-8432
Mailing Address - Fax:
Practice Address - Street 1:500 W 1ST AVE STE A
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3923
Practice Address - Country:US
Practice Address - Phone:509-396-7984
Practice Address - Fax:509-396-7985
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2025-03-07
Deactivation Date:2025-02-26
Deactivation Code:
Reactivation Date:2025-03-05
Provider Licenses
StateLicense IDTaxonomies
WAMA60012264225700000X
WAAP61664008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist