Provider Demographics
NPI:1649487927
Name:WICKS, KIMBERLI ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLI
Middle Name:ANN
Last Name:WICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 SE SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2537
Mailing Address - Country:US
Mailing Address - Phone:582-333-1364
Mailing Address - Fax:
Practice Address - Street 1:1277 SE SHELTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2537
Practice Address - Country:US
Practice Address - Phone:582-333-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health