Individual
MARK WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MT-BC
Contact information
Practice address
196 QUEEN ST, SOUTHINGTON, CT 06489-1901
(860) 518-5777
Mailing address
196 QUEEN ST, SOUTHINGTON, CT 06489-1901
(860) 518-5777
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
78
CT
Other
Enumeration date
08/20/2025
Last updated
08/20/2025
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