Healthcare Provider Details

I. General information

NPI: 1467300863
Provider Name (Legal Business Name): ALLISON WICKHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FOSTER ST
WORCESTER MA
01608-1715
US

IV. Provider business mailing address

169 LELAND HILL RD
SUTTON MA
01590-2911
US

V. Phone/Fax

Practice location:
  • Phone: 774-258-2652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: