Healthcare Provider Details

I. General information

NPI: 1033612502
Provider Name (Legal Business Name): CASEY WIKIERA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

3 IRONSIDE CT
SAINT CHARLES MO
63303-2916
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011024092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: