Provider Demographics
NPI:1760634539
Name:WICKS, JOCELYN ELAINE (MS)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ELAINE
Last Name:WICKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:ELAINE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:602 SHELTER BAY DR
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-9530
Mailing Address - Country:US
Mailing Address - Phone:360-931-3471
Mailing Address - Fax:
Practice Address - Street 1:320 PACIFIC PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5463
Practice Address - Country:US
Practice Address - Phone:360-416-7593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health