Individual
KELLY WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D., LP
Contact information
Practice address
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405-1430
(612) 871-1454
(612) 871-1505
Mailing address
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405-1430
(612) 871-1454
(612) 871-1505
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP5806
MN
Other
Enumeration date
12/03/2014
Last updated
10/13/2016
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