Individual
MR. DAVID ALFRED WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ADDICTION THERAPIST
Contact information
Practice address
10 TRI PARK WAY, APPLETON, WI 54914-1658
(920) 831-7908
(920) 831-7984
Mailing address
1836 PREBLE AVE, GREEN BAY, WI 54302-2937
(920) 437-3863
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1624
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1624
WIS. CERTIFICATION BOARD
WI
Enumeration date
09/15/2006
Last updated
07/08/2007
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