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General NPI Number Information
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NPI Number | 1952935116
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Entity Type | Individual
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Provider Name | JONATHAN MAURICE WICKS ASW
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Gender | Male
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 943 N GRAND AVE
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City | COVINA
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State | CA
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Zip | 91724-2046
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Country | US
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Telephone | 626-665-6431
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Fax |
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Provider Business Mailing Address
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Address Line | 112 HARVARD AVE # 395
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City | CLAREMONT
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State | CA
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Zip | 91711-4716
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 87395
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117641
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License Number State | CA
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