| Doctor Name: | SUSAN M WICKLUND |
| NPI Number: | 1487624953 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 7268 |
| Business Practice Address: | 207 S Main St Livingston, MT - 590473016 |
| Business Phone Number: | 4062227555 |
| Business Fax Number: | |
| Mailing Address: | 207 S Main St, LIVINGSTON |
| State: | MT |
| Postal Code: | 590473016 |
| Phone Number: | 4062227555 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2006 |
| NPI Last Update Date: | 03/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 7268 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |