Provider Demographics
NPI:1144233271
Name:WICKS, ROLF EDWIN (LISW)
Entity Type:Individual
Prefix:
First Name:ROLF
Middle Name:EDWIN
Last Name:WICKS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MORELEY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2025
Mailing Address - Country:US
Mailing Address - Phone:330-338-8429
Mailing Address - Fax:
Practice Address - Street 1:445 W LIBERTY ST
Practice Address - Street 2:SUITE 225
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2273
Practice Address - Country:US
Practice Address - Phone:330-331-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15023911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical