Provider Demographics
NPI:1619133543
Name:WICKER, MARLA MCALLISTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:MCALLISTER
Last Name:WICKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 RAEFORD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3074
Mailing Address - Country:US
Mailing Address - Phone:910-488-4100
Mailing Address - Fax:910-483-8721
Practice Address - Street 1:5330 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3074
Practice Address - Country:US
Practice Address - Phone:910-488-4100
Practice Address - Fax:910-483-8721
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist