Basic Information
| Provider Information | |||||||||
| NPI: | 1215549472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WICKER | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CADC-R, CGAC II, CRM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17818 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973057818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035405554 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3321 HAROLD DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033632021 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2020 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.