Provider Demographics
NPI:1477600435
Name:WICHMANN, JILL BERNICE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:BERNICE
Last Name:WICHMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 MANGROVE AVE # 159
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2648
Mailing Address - Country:US
Mailing Address - Phone:530-680-0724
Mailing Address - Fax:
Practice Address - Street 1:1351 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4900
Practice Address - Country:US
Practice Address - Phone:530-680-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28514OtherBBS