Individual
CATHERINE WICKSTRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4966 W PHILOMENA ST, MERIDIAN, ID 83646-4657
(805) 551-4156
Mailing address
4966 W PHILOMENA ST, MERIDIAN, ID 83646-4657
(805) 551-4156
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/27/2020
Last updated
02/05/2021
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