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General NPI Number Information
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NPI Number | 1700515020
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Entity Type | Individual
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Provider Name | ELIZABETH WICKLIFFE BS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 6130 COUNTY ROAD 427
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City | AUBURN
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State | IN
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Zip | 46706-9515
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Country | US
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Telephone | 260-920-0784
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Fax |
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Provider Business Mailing Address
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Address Line | 790 S 600 E
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City | AVILLA
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State | IN
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Zip | 46710-9620
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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