Provider Demographics
NPI:1669645503
Name:JOSEPH F. WICKER, PSY.D. CLINICAL PSYCHOLOGIST, LLC.
Entity Type:Organization
Organization Name:JOSEPH F. WICKER, PSY.D. CLINICAL PSYCHOLOGIST, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:513-528-2245
Mailing Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Mailing Address - Street 2:306E
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3400
Mailing Address - Country:US
Mailing Address - Phone:513-528-2245
Mailing Address - Fax:513-528-2184
Practice Address - Street 1:4030 MOUNT CARMEL TOBASCO RD
Practice Address - Street 2:306E
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3400
Practice Address - Country:US
Practice Address - Phone:513-528-2245
Practice Address - Fax:513-528-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0646742Medicaid
OH0646742Medicaid