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NPI Code Detail

MEDICARE: MRS. CLARA HUTSON WICKER M.ED.,CCC-SLP

MEDICARE: MRS. CLARA HUTSON WICKER M.ED.,CCC-SLP
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
1235Z00000XSpeech-Language Pathologist2860LA

General Provider Information

NPI Number : 1407059579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CLARA HUTSON WICKER M.ED.,CCC-SLP
Provider Business Mailing Address
First Line : 6411 OAK CLUSTER DR
Second Line :
City : GREENWELL SPRINGS
State : LA
Zip : 70739-4132
Country : US
Telephone Number : 225-261-5771
Fax Number :
Provider Business Practice Location Address
First Line : 6411 OAK CLUSTER DRIVE
Second Line :
City : GREENWELL SPRINGS
State : LA
Zip : 70739
Country : US
Telephone Number : 225-261-5771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2007
Last Update Date : 08/24/2007

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Directions to “ MRS. CLARA HUTSON WICKER M.ED.,CCC-SLP” Practice Location

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