MEDICARE: BRENT WICKSTROM

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	103K00000X	Behavior Analyst	1-24-76014	NC

General Provider Information

NPI Number	:	1225533029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT WICKSTROM

Provider Business Mailing Address
First Line	:	3131 RDU CENTER DR STE 135
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7687
Country	:	US
Telephone Number	:	984-849-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 RDU CENTER DR STE 135
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-7687
Country	:	US
Telephone Number	:	984-849-4447
Fax Number	:

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	10/10/2024

Similar Medicare Providers

1558216523 — TAYLOR LAVIN
Practice Location Address:

3131 RDU CENTER DR
MORRISVILLE, NC
27560-7687

Practice Phone: 984-319-4967
Practice Fax:

1275003345 — LAURYN DRAY
Practice Location Address:

3131 RDU CENTER DR
MORRISVILLE, NC
27560-7687

Practice Phone: 815-546-8803
Practice Fax:

1801143946 — MS. NEELAM HARIHARPRASAD CHAUDHARY PT
Practice Location Address:

101 HOLLY CREEK RD
MORRISVILLE, NC
27560-9775

Practice Phone: 919-350-9330
Practice Fax: 919-341-3576

1235587890 — MRS. ASHLEY RANDLEMAN CHAZANOW CPNP
Practice Location Address:

101 HOLLY CREEK RD
MORRISVILLE, NC
27560-9509

Practice Phone: 919-235-6512
Practice Fax:

1740819549 — JACKELINE CHAPARRO LORENZO LARKER DO
Practice Location Address:

6102 GRACE PARK DR
MORRISVILLE, NC
27560-6003

Practice Phone: 919-235-6480
Practice Fax:

1043951528 — DR. STRAHINJA TALIC DO
Practice Location Address:

101 HOLLY CREEK RD
MORRISVILLE, NC
27560-9509

Practice Phone: 919-235-6545
Practice Fax:

Directions to “ BRENT WICKSTROM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.