Individual
MISS CARLA M WIKSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
600 N. HOLTZCLAW - SUITE 200, CHATTANOOGA, TN 37404-1240
(423) 622-6900
(423) 622-4834
Mailing address
600 N. HOLTZCLAW - SUITE 200, CHATTANOOGA, TN 37404-1240
(423) 622-6900
(423) 622-4834
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
SLP003415
GA
235Z00000X
Speech-Language Pathologist
Primary
SP0000001023
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3060846
BCBST ID #
TN
05
—
3060846
—
TN
01
—
4640001
UNITEDHEALTHCARE ID#
TN
Enumeration date
07/25/2006
Last updated
07/09/2007
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