Provider Demographics
NPI:1235483884
Name:WICKS, TRISHA LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:LYNN
Last Name:WICKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 24
Mailing Address - Street 2:460 6TH STREET,
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-0024
Mailing Address - Country:US
Mailing Address - Phone:515-978-6017
Mailing Address - Fax:
Practice Address - Street 1:460 6TH STREET
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-0024
Practice Address - Country:US
Practice Address - Phone:515-978-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03008173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist