Healthcare Provider Details

I. General information

NPI: 1336880434
Provider Name (Legal Business Name): CASSIE ANNE WICKEN MD, MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

IV. Provider business mailing address

1209 N CHARLES ST APT 109
BALTIMORE MD
21201-5657
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax:
Mailing address:
  • Phone: 707-338-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA210667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: