Provider Demographics
NPI:1194465104
Name:WICKERSHAM, TOD (FNLP, CFNC, OM)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:
Last Name:WICKERSHAM
Suffix:
Gender:M
Credentials:FNLP, CFNC, OM
Other - Prefix:
Other - First Name:THEODORE
Other - Middle Name:SAVAGE
Other - Last Name:WICKERSHAM
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9206 ASHWORTH DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-9196
Mailing Address - Country:US
Mailing Address - Phone:202-322-2267
Mailing Address - Fax:
Practice Address - Street 1:9206 ASHWORTH DR
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-9196
Practice Address - Country:US
Practice Address - Phone:202-322-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174H00000XOther Service ProvidersHealth Educator