Provider Demographics
NPI:1487022042
Name:CWICK, MANDY (MHP)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:CWICK
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-1990
Mailing Address - Country:US
Mailing Address - Phone:815-404-7891
Mailing Address - Fax:
Practice Address - Street 1:527 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3756
Practice Address - Country:US
Practice Address - Phone:815-404-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health