Individual
MR. MATTHEW DAVID WICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27880 N 64TH STREET, SCOTTSDALE, AZ 85262
(480) 202-8454
Mailing address
29862 N TATUM BLVD, 2069, CAVE CREEK, AZ 85331-5860
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
4058847
AZ
Other
Enumeration date
11/04/2008
Last updated
11/04/2008
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