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Individual
MR. DAVID ALFRED WICKMAN
Active
Individual
MR. DAVID ALFRED WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ADDICTION THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1624
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1624
WIS. CERTIFICATION BOARD
WI
Enumeration date
09/15/2006
Last updated
07/08/2007
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