Active NPI
Theresa Wicklund
- Developmental Therapist
- Florence, KY
National Provider Identifier
1376905943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 4900 Houston Rd
Florence, KY 41042-4824 - Phone
- (859) 655-1195
- Fax
- (859) 655-1194
- NPI assigned
- Mar 23, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | KY | Primary |
Addresses
Primary practice location
4900 Houston Rd
Florence, KY 41042-4824
Mailing address
4900 Houston Rd
Florence, KY 41042-4824
Phone (859) 655-1195
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201114472 | Other | KY | IECE CERTIFICATION |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | theresa.wicklund@stelizabeth.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590019200000",
"number": "1376905943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4900 HOUSTON RD",
"city": "FLORENCE",
"state": "KY",
"postal_code": "410424824",
"telephone_number": "859-655-1195",
"fax_number": "859-655-1194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4900 HOUSTON RD",
"city": "FLORENCE",
"state": "KY",
"postal_code": "410424824",
"telephone_number": "859-655-1195",
"fax_number": "859-655-1194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKLUND",
"first_name": "THERESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-23",
"last_updated": "2020-05-21",
"certification_date": "2020-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "KY",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IECE CERTIFICATION",
"identifier": "201114472",
"state": "KY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "theresa.wicklund@stelizabeth.com",
"affiliation": "N",
"endpointDescription": "work email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "St. Elizabeth Healthcare",
"address_1": "4900 Houston Rd",
"city": "Florence",
"state": "KY",
"country_code": "US",
"postal_code": "410424824",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Florence, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.