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General NPI Number Information
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NPI Number | 1669680609
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Entity Type | Individual
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Provider Name | CHRISTIE ANN WICK LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 17800 EXCELSIOR BLVD
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City | MINNETONKA
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State | MN
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Zip | 55345-4246
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Country | US
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Telephone | 612-910-3108
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Fax |
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Provider Business Mailing Address
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Address Line | 17800 EXCELSIOR BLVD
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City | MINNETONKA
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State | MN
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Zip | 55345-4246
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Country | US
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Telephone | 612-910-3108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1039
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License Number State | MN
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