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NPI Code Detail

MEDICARE: CODY WICKEN

MEDICARE: CODY WICKEN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1487395414
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODY WICKEN
Provider Business Mailing Address
First Line : PO BOX 876741
Second Line :
City : WASILLA
State : AK
Zip : 99687-6741
Country : US
Telephone Number : 907-373-4732
Fax Number : 907-746-4749
Provider Business Practice Location Address
First Line : 51310 TIMBER BAY CT
Second Line :
City : HOMER
State : AK
Zip : 99603-9812
Country : US
Telephone Number : 907-235-3250
Fax Number : 907-235-3251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2022
Last Update Date : 04/05/2022

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Directions to “ CODY WICKEN ” Practice Location

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