Provider Demographics
NPI:1851130645
Name:KAVICKY, KATIE RALENE (ND)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:RALENE
Last Name:KAVICKY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 S HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54229-9508
Mailing Address - Country:US
Mailing Address - Phone:920-288-2601
Mailing Address - Fax:
Practice Address - Street 1:2571 S HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54229-9508
Practice Address - Country:US
Practice Address - Phone:920-288-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6054170175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath