Provider Demographics
NPI:1255409207
Name:WICKLUND, CATHERINE ANN (MS, CGC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-926-7468
Mailing Address - Fax:312-926-3553
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1280
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-7468
Practice Address - Fax:312-926-3553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS