MEDICARE: ERIKA ROXANNE WYCKOFF MSW, 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	30937	TX

General Provider Information

NPI Number	:	1588720254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA ROXANNE WYCKOFF MSW, LCSW

Provider Business Mailing Address
First Line	:	8231 FREDERICKSBURG RD
Second Line	:	SEVILLE OFFICE PARK (UNDER THE CLOCK TOWER)
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-550-7478
Fax Number	:

Provider Business Practice Location Address
First Line	:	8231 FREDERICKSBURG RD
Second Line	:	SEVILLE OFFICE PARK (UNDER THE CLOCK TOWER)
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3356
Country	:	US
Telephone Number	:	210-550-7478
Fax Number	:

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	09/17/2012

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