Individual
DR. AMANDA M. WICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, H.S.P.P.
Contact information
Practice address
1807 SMITH ST, LOGANSPORT, IN 46947-1576
(574) 732-1414
(574) 732-0504
Mailing address
1807 SMITH ST, LOGANSPORT, IN 46947-1576
(574) 732-1414
(574) 732-0504
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042052A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20042052A
HSPP LICENSE
IN
Enumeration date
06/28/2006
Last updated
07/08/2007
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