Individual
JASON B WICKLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 SUN VALLEY DR, SAINT ALBANS, WV 25177-3523
(304) 552-9384
Mailing address
403 SUN VALLEY DR, SAINT ALBANS, WV 25177-3523
(304) 552-9384
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
22-9273
WV
Other
Enumeration date
12/23/2022
Last updated
01/16/2023
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