Individual
MR. KERRY W. WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAC, LPCC
Contact information
Practice address
3952 HIGHWAY 281 SE, JAMESTOWN, ND 58401-9408
(701) 252-8939
Mailing address
3952 HIGHWAY 281 SE, JAMESTOWN, ND 58401-9408
(701) 252-8939
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9202
BCBS IDENTIFIER
ND
01
—
WIC17788
BCBS IDENTIFIER
ND
Enumeration date
10/11/2006
Last updated
07/08/2007
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