Provider Demographics
NPI:1548872286
Name:WICKS, STEPHEN JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:WICKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1409 WOLFF ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1106
Mailing Address - Country:US
Mailing Address - Phone:720-645-4613
Mailing Address - Fax:
Practice Address - Street 1:12705 E MONTVIEW BLVD STE 400
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7112
Practice Address - Country:US
Practice Address - Phone:303-724-3894
Practice Address - Fax:303-724-3096
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics