Provider Demographics
NPI:1407059579
Name:WICKER, CLARA HUTSON (MED,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:HUTSON
Last Name:WICKER
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 OAK CLUSTER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4132
Mailing Address - Country:US
Mailing Address - Phone:225-261-5771
Mailing Address - Fax:
Practice Address - Street 1:6411 OAK CLUSTER DRIVE
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739
Practice Address - Country:US
Practice Address - Phone:225-261-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist