Basic Information
| Provider Information | |||||||||
| NPI: | 1932714565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WICKERSHAM | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | FRANCESCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 PACIFIC AVE | ||||||||
| Address2: | SUITE C-3 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6201 PACIFIC AVE | ||||||||
| Address2: | SUITE C-3 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638853 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2020 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.