Provider Demographics
NPI:1245687268
Name:WICKER, PORSHIA SADE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PORSHIA
Middle Name:SADE
Last Name:WICKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-5907
Mailing Address - Country:US
Mailing Address - Phone:919-770-6649
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-5907
Practice Address - Country:US
Practice Address - Phone:919-770-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist