Provider Demographics
NPI:1023303823
Name:KISELICKA-SICKMILLER, NICOLE MARIE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:KISELICKA-SICKMILLER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SAN PEDRO DR NE
Mailing Address - Street 2:APT 227
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2014
Mailing Address - Country:US
Mailing Address - Phone:505-336-0422
Mailing Address - Fax:
Practice Address - Street 1:4201 SAN PEDRO DR NE
Practice Address - Street 2:APT 227
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2014
Practice Address - Country:US
Practice Address - Phone:505-336-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst