Provider Demographics
NPI:1184327256
Name:WICHMANN, CHRISTOPHER CHAD (CRADC, MARS, AND CS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHAD
Last Name:WICHMANN
Suffix:
Gender:M
Credentials:CRADC, MARS, AND CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 E MCDANIEL ST APT 19
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-3440
Mailing Address - Country:US
Mailing Address - Phone:417-761-2049
Mailing Address - Fax:
Practice Address - Street 1:1348 E MCDANIEL ST APT 19
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3440
Practice Address - Country:US
Practice Address - Phone:417-761-2049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13865101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)