Individual
MRS. CHARLENE M WICHERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
2615 E RANDOLPH AVE, ENID, OK 73701-4670
(580) 234-3734
(580) 234-3554
Mailing address
2615 E RANDOLPH AVE, ENID, OK 73701-4670
(580) 234-3734
(580) 234-3554
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2181
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100662450A
—
OK
Enumeration date
02/01/2007
Last updated
07/09/2009
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