| NPI | 1811926801 |
|---|---|
| Former Name | KELLY L. WICKERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121397) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-3332) |
| 1041C0700X Social Worker, Clinical (Licence: MA 111808) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2021-04-16 |