Provider Demographics
NPI:1861558884
Name:WICK, ROBERT LEE (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:WICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8914
Mailing Address - Country:US
Mailing Address - Phone:920-459-9277
Mailing Address - Fax:920-459-7920
Practice Address - Street 1:5934 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8914
Practice Address - Country:US
Practice Address - Phone:920-459-9277
Practice Address - Fax:920-459-7920
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24301231041C0700X
WI177124106H00000X
WI12399131101YA0400X
WI2430-123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional