| Doctor Name: | MR. JOHN WILLIAM WICKENBURG |
| NPI Number: | 1750432597 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 17669 |
| Business Practice Address: | 401 Bicentennial Way Santa Rosa, CA - 954032149 |
| Business Phone Number: | 7075714633 |
| Business Fax Number: | |
| Mailing Address: | 1684 Norte Way, SANTA ROSA |
| State: | CA |
| Postal Code: | 954042611 |
| Phone Number: | 7075251988 |
| Fax Number: | 7075251988 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171M00000X |
| License Number: | 17669 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Case Manager/Care Coordinator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee |