Individual
SUSAN L WICKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
313 ROBIN LN, SALLISAW, OK 74955-3028
(609) 346-8746
Mailing address
313 ROBIN LN, SALLISAW, OK 74955-3028
(609) 346-8746
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
58992
TX
1041C0700X
Clinical Social Worker
9610
LA
1041C0700X
Clinical Social Worker
C006886
NC
Other
Enumeration date
09/20/2010
Last updated
04/11/2019
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