Provider Demographics
NPI:1295931103
Name:HAUPRICH, WICK JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:WICK
Middle Name:JOSEPH
Last Name:HAUPRICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12509
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-5509
Mailing Address - Country:US
Mailing Address - Phone:818-957-4239
Mailing Address - Fax:
Practice Address - Street 1:1502 W WEST COVINA PKWY
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2703
Practice Address - Country:US
Practice Address - Phone:626-480-5234
Practice Address - Fax:626-480-5109
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16665103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth