Healthcare Provider Details

I. General information

NPI: 1588720254
Provider Name (Legal Business Name): ERIKA ROXANNE WYCKOFF MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8231 FREDERICKSBURG RD SEVILLE OFFICE PARK (UNDER THE CLOCK TOWER)
SAN ANTONIO TX
78229-3356
US

IV. Provider business mailing address

8231 FREDERICKSBURG RD SEVILLE OFFICE PARK (UNDER THE CLOCK TOWER)
SAN ANTONIO TX
78229-3356
US

V. Phone/Fax

Practice location:
  • Phone: 210-550-7478
  • Fax:
Mailing address:
  • Phone: 210-550-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30937
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: