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Individual

JAMIE WICKERSHIEM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
17500 W BLUEMOUND RD, STE B, BROOKFIELD, WI 53045-2909
(262) 901-2800
(262) 784-2914
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2222

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6311
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40327600
WI
Enumeration date
07/27/2006
Last updated
04/10/2017
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