Individual
KATHY WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1398 E LUCK LN, MILLCREEK, UT 84106-2944
(801) 251-6767
Mailing address
1877 S WYOMING ST, SALT LAKE CITY, UT 84108-3235
(801) 712-1441
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10570331-6004
UT
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/09/2008
Last updated
09/20/2022
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