Provider Demographics
NPI:1720028087
Name:WICKER, SHARON (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:WICKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FAIRFAX ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3617
Mailing Address - Country:US
Mailing Address - Phone:703-777-6424
Mailing Address - Fax:703-777-6456
Practice Address - Street 1:29 FAIRFAX ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3617
Practice Address - Country:US
Practice Address - Phone:703-777-6424
Practice Address - Fax:703-777-6456
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201-001122231H00000X
VA2101-001388237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010142725Medicaid
VA010142717Medicaid
VA010142717Medicaid