Provider Demographics
NPI:1497235923
Name:WICK, CLAIRE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:WICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ELIZABETH
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:191 JEWEL BASIN CT
Mailing Address - Street 2:STE 3D
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6294
Mailing Address - Country:US
Mailing Address - Phone:406-201-9711
Mailing Address - Fax:
Practice Address - Street 1:191 JEWEL BASIN CT STE 3D
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6294
Practice Address - Country:US
Practice Address - Phone:406-201-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786671041C0700X
MTBBH-LCSW-LIC-310261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical