Provider Demographics
NPI:1548337173
Name:WICKER, JULIE KATHERINE (MSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KATHERINE
Last Name:WICKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 2ND ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-5004
Mailing Address - Country:US
Mailing Address - Phone:218-724-3122
Mailing Address - Fax:218-724-4041
Practice Address - Street 1:25 N 12TH AVE E
Practice Address - Street 2:SUITE F
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2200
Practice Address - Country:US
Practice Address - Phone:218-724-3122
Practice Address - Fax:218-724-4041
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN064431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN965514000Medicaid
MN809000550Medicare ID - Type Unspecified