Provider Demographics
NPI:1790813343
Name:WICKS, MANDI ANNA (BSW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:ANNA
Last Name:WICKS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 LIBERTY PIKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8500
Mailing Address - Country:US
Mailing Address - Phone:615-599-7777
Mailing Address - Fax:
Practice Address - Street 1:1450 14TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3005
Practice Address - Country:US
Practice Address - Phone:615-298-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator