| Doctor Name: | KELLY ANN WICKER |
| NPI Number: | 1023338936 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCMHC |
| License Number: | 068.0057705 |
| Business Practice Address: | 550 Rt. 30 Newfane, VT - 05345 |
| Business Phone Number: | 8023657001 |
| Business Fax Number: | |
| Mailing Address: | 1513 Abbott Rd, WINDHAM |
| State: | VT |
| Postal Code: | 053599676 |
| Phone Number: | 8023657001 |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2010 |
| NPI Last Update Date: | 06/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068.0057705 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |