Provider Demographics
NPI:1164856878
Name:WICKWARE, ALANA (BS, SWDB-2)
Entity type:Individual
Prefix:MRS
First Name:ALANA
Middle Name:
Last Name:WICKWARE
Suffix:
Gender:F
Credentials:BS, SWDB-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 STATE ROUTE 143
Mailing Address - Street 2:
Mailing Address - City:COEYMANS HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:12046-2102
Mailing Address - Country:US
Mailing Address - Phone:518-756-9443
Mailing Address - Fax:
Practice Address - Street 1:14379 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143
Practice Address - Country:US
Practice Address - Phone:518-756-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1911359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist