Individual
MRS. AMANDA BROOKE WICHERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. SLP-CCC
Contact information
Practice address
3572 CANNONADE CT STE B, WEST LAFAYETTE, IN 47906-4632
(405) 762-9411
Mailing address
3572 CANNONADE CT, WEST LAFAYETTE, IN 47906-4632
(405) 762-9411
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006582A
IN
235Z00000X
Speech-Language Pathologist
4169
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200527550A
—
OK
Enumeration date
02/18/2015
Last updated
04/06/2023
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