Provider Demographics
NPI:1942854179
Name:WICK, JAMIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
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 1:1338 COMMERCE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3726
Mailing Address - Country:US
Mailing Address - Phone:360-986-3591
Mailing Address - Fax:360-768-5547
Practice Address - Street 1:1338 COMMERCE AVE STE 212
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3726
Practice Address - Country:US
Practice Address - Phone:360-986-3591
Practice Address - Fax:360-768-5547
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator