Provider Demographics
NPI:1962787218
Name:KLICKA, ABIGAIL M (LAT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:KLICKA
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:HALDIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BELLIN HEALTH 1970 S. RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-430-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1158-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer