MEDICARE: KATHRYN WICKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1013877489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN WICKE

Provider Business Mailing Address
First Line	:	10100 ELIDA RD
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 LEXINGTON RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-2816
Country	:	US
Telephone Number	:	419-695-8010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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