Provider Demographics
NPI:1740337302
Name:WIKERD, CAROL ANN (MA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:WIKERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5707
Mailing Address - Country:US
Mailing Address - Phone:610-264-8866
Mailing Address - Fax:
Practice Address - Street 1:3005 BRODHEAD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9201
Practice Address - Country:US
Practice Address - Phone:610-264-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist