Provider Demographics
NPI:1851410922
Name:WICK, STEPHANIE LEANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEANN
Last Name:WICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 POYNTZ AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6760
Mailing Address - Country:US
Mailing Address - Phone:785-539-5455
Mailing Address - Fax:
Practice Address - Street 1:1019 POYNTZ AVE STE C
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6760
Practice Address - Country:US
Practice Address - Phone:785-539-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist