Individual
EMILY ANN WICKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301
(920) 431-5555
(920) 430-4745
Mailing address
840 APHRODITE RD, GREEN BAY, WI 54311-5460
(920) 433-5555
(920) 430-4745
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3362-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100009898
—
WI
Enumeration date
06/24/2010
Last updated
12/21/2010
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