Provider Demographics
NPI:1982968434
Name:WICKLUND, LINDA GAIL
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:GAIL
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2625
Mailing Address - Country:US
Mailing Address - Phone:307-235-2814
Mailing Address - Fax:307-472-1169
Practice Address - Street 1:918 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2625
Practice Address - Country:US
Practice Address - Phone:307-235-2814
Practice Address - Fax:307-472-1169
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator