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General NPI Number Information
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NPI Number | 1386716983
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Entity Type | Organization
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Legal Business Name | MAPLEWOOD PSYCHOLOGY P.A.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 2399 ARIEL ST N STE D
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2203
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Country | US
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Telephone | 651-770-1311
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Fax | 651-770-1879
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Provider Business Mailing Address
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Address Line | 2399 ARIEL ST N STE D
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2203
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Country | US
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Telephone | 651-770-1311
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Fax | 651-770-1879
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SANDRA M WICK
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Credential | PHD, LP
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Telephone | 651-770-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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