Amy Wicker, O.T., LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23668 Issued in MN

Practice address

101 W 2ND St
Duluth, MN 55802-2086

Phone

(218) 724-3122

Fax

(218) 724-4041

NPI assigned

May 9, 2011

Last updated

May 5, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iron Range Behavioral Services, LLC

  • Community/Behavioral Health Agency
  • Virginia, MN
  • NPI 1851900484

  Clinical

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493942400000",
    "number": "1902198088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022086",
            "telephone_number": "218-724-3122",
            "fax_number": "218-724-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558022086",
            "telephone_number": "218-724-3122",
            "fax_number": "218-724-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKER",
        "first_name": "AMY",
        "credential": "O.T., LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-09",
        "last_updated": "2017-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "MN",
            "license": "103868",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Whittaker
• Matthew Thomas Whitting, MA, LADC
• Chloe M Whittington, LICSW
• Anne B Whitworth, MD
• Savanna Wick
• Julie Katherine Wicker, MSW
• Rachel D Wickstrom, LADC
• Luke David Widstrom, D.O.
• Mark Kenneth Widstrom
• Jason Wiederin, MD

• Clinical Social Worker in Duluth, MN
• Providers in Duluth, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.