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General NPI Number Information
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NPI Number | 1689339905
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Entity Type | Individual
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Provider Name | MICHELLE WICKIZER PSY.D
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Gender | Female
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 1229 LAKE PLAZA DR STE A
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-7401
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Country | US
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Telephone | 719-313-2578
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Fax | 719-735-4952
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Provider Business Mailing Address
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Address Line | PO BOX 38553
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City | COLORADO SPRINGS
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State | CO
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Zip | 80937-8553
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Country | US
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Telephone | 719-313-2578
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Fax | 719-434-9811
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY.0005676
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License Number State | CO
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