Individual provider · NPI-1

Dr. Michael Allen Boticki, Ph.D.

Counselor, Professional · Racine, WI

NPI number1255340642
StatusActive
Last updated in NPPESJul 9, 2007

Details

NPI
1255340642
Entity type
Individual (NPI-1)
Name
Dr. Michael Allen Boticki
Credential
Ph.D.
Sex
Male
Sole proprietor
No
Enumeration date
Aug 5, 2006
Last updated
Jul 9, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YP2500X Counselor, Professional40910900WIYes

Practice location

1220 Mound Ave Ste 301
Racine, WI 53404-3350

Phone 262-633-3591

Mailing address

7127 Old Spring St
Racine, WI 53406-3304

Phone 262-456-0707

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