Individual
KACY WICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11112 SCRIMSHAW LN, CHARLOTTE, NC 28215-8304
(704) 258-7031
Mailing address
11112 SCRIMSHAW LN, CHARLOTTE, NC 28215-8304
(704) 258-7031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12381
NC
235Z00000X
Speech-Language Pathologist
6006
SC
235Z00000X
Speech-Language Pathologist
SLP011439
GA
Other
Enumeration date
03/22/2017
Last updated
02/07/2022
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