MEDICARE: DR. FRAN S WICKNER PH.D., MFT

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	106H00000X	Marriage & Family Therapist	MFC18676	CA

General Provider Information

NPI Number	:	1912037334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRAN S WICKNER PH.D., MFT

Provider Business Mailing Address
First Line	:	1350-A SOLANO AVENUE
Second Line	:	SUITE #4
City	:	ALBANY
State	:	CA
Zip	:	94706
Country	:	US
Telephone Number	:	510-527-4011
Fax Number	:	510-527-4011

Provider Business Practice Location Address
First Line	:	1350 A SOLANO AVENUE
Second Line	:	SUITE #4
City	:	ALBANY
State	:	CA
Zip	:	94706
Country	:	US
Telephone Number	:	510-527-4011
Fax Number	:	510-527-4011

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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