| Doctor Name: | EMILY ANN WICKERT |
| NPI Number: | 1992016935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SLP |
| License Number: | 3362-154 |
| Business Practice Address: | 744 S Webster Ave Green Bay, WI - 54301 |
| Business Phone Number: | 9204315555 |
| Business Fax Number: | 9204304745 |
| Mailing Address: | 840 Aphrodite Rd, GREEN BAY |
| State: | WI |
| Postal Code: | 543115460 |
| Phone Number: | 9204335555 |
| Fax Number: | 9204304745 |
| NPI Enumeration Date: | 06/24/2010 |
| NPI Last Update Date: | 12/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3362-154 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |