Individual
DR. KURT AUSTIN WICAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3499 LEXINGTON AVE N, SUITE 100, SAINT PAUL, MN 55126-7055
(651) 486-4828
(651) 482-9119
Mailing address
3499 LEXINGTON AVE N, SUITE 100, SAINT PAUL, MN 55126-7055
(651) 486-4828
(651) 482-9119
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1357
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
523K5WI
BCBS GROUP ID
MN
01
—
525K5WI
BCBS PERSONAL ID
MN
01
—
6190551
UBH PIN
MN
01
—
HP53169
HEALTHPARTNERS PIN
MN
Enumeration date
12/18/2006
Last updated
07/08/2007
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