Mackenzie Wickman
Individual provider Active NPI Dental Hygienist · Lakewood, WI
NPI 1104297571 · NPPES record last updated Oct 31, 2024
Key facts
- NPI
- 1104297571
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 1002641 (WI)
- Practice address
- 15397 State Highway 32
Lakewood, WI 54138-9702 - Phone
- (715) 276-6321
- Fax
- (715) 276-1428
- NPI assigned
- Oct 12, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1002641 | WI | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Lakes Community Health Center, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 1002641 | WI | Yes |
Addresses
Primary practice location
15397 State Highway 32
Lakewood, WI 54138-9702
Mailing address
PO Box 179
Lakewood, WI 54138-0179
Phone (715) 276-6321
Other providers in Lakewood, WI
- Sharon K. Shepich
- Holly Marie Spletzer
- Anastasia Starzer
- The Lakes Community Health Center, Inc
- Tammy J Whitt-Sylfest
- Michael W Wixom
- Zachary Yurich
All providers in Lakewood, WI · Dental Hygienist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.