Individual
MS. LEEANN WICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 203-1940
Mailing address
15855 19 MILE RD, CLINTON TWP, MI 48038-3504
(586) 203-1940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601001022
MI
Other
Enumeration date
05/03/2012
Last updated
03/10/2021
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