Provider Demographics
NPI:1922206226
Name:WICKS, SHEILA MICHELLE (BSC MS MB,MBA,LAC)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:MICHELLE
Last Name:WICKS
Suffix:
Gender:F
Credentials:BSC MS MB,MBA,LAC
Other - Prefix:PROF
Other - First Name:SHEILA
Other - Middle Name:MICHELLE
Other - Last Name:WICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSC, MS, MB, MBA,LAC
Mailing Address - Street 1:4800 S CHICAGO BEACH DR APT 311S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-7019
Mailing Address - Country:US
Mailing Address - Phone:312-933-5204
Mailing Address - Fax:
Practice Address - Street 1:356 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3416
Practice Address - Country:US
Practice Address - Phone:312-932-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered171100000XOther Service ProvidersAcupuncturist