MEDICARE: CLAIRE ELIZABETH WICK LCSW

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	1041C0700X	Clinical Social Worker	78667	CA
2	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-31026	MT

General Provider Information

NPI Number	:	1497235923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE ELIZABETH WICK LCSW

Provider Business Mailing Address
First Line	:	191 JEWEL BASIN CT
Second Line	:	STE 3D
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-201-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 JEWEL BASIN CT STE 3D
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-201-9711
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	12/14/2021

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