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General NPI Number Information
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NPI Number | 1942705652
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Entity Type | Individual
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Provider Name | ANDREA DENISE WICKERSHAM PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 117 OLD SOLDIERS LN
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City | FRANKFORT
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State | KY
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Zip | 40601-6159
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Country | US
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Telephone | 502-875-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 PARK PLACE DR
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City | RICHMOND
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State | KY
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Zip | 40475-3442
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Country | US
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Telephone | 859-582-7433
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 129186
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License Number State | KY
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