Individual
MICHAEL WICKERSHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3970 S 700 E STE 17, SALT LAKE CITY, UT 84107-2583
(801) 639-9544
(801) 263-4333
Mailing address
3970 S 700 E STE 17, SALT LAKE CITY, UT 84107-2583
(801) 639-9544
(801) 263-4333
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9428093-3502
UT
Other
Enumeration date
11/10/2015
Last updated
06/20/2016
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