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NPI Profile for KELLY A WICKER in NEWFANE, VT.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X |
| NPI # | 1023338936 |
|
| Status | Active | |
| Credentials | LCMHC | |
| Entity | Individual | |
| Enumeration date | 06/03/2010 | |
| Last updated | 06/03/2010 - About 16 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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KELLY A WICKER
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