Michael Wickersham

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9428093-3502 Issued in UT

Practice address

3970 S 700 E Ste 17
Salt Lake City, UT 84107-2583

Phone

(801) 639-9544

Fax

(801) 263-4333

NPI assigned

Nov 10, 2015

Last updated

Jun 20, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

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.

• Compass Counseling and Consulting

  • Community/Behavioral Health Agency
  • Salt Lake City, UT
  • NPI 1356669360
  Medicare reassignment NPD

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1932572161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 S 700 E STE 17",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072583",
            "telephone_number": "801-639-9544",
            "fax_number": "801-263-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 S 700 E STE 17",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072583",
            "telephone_number": "801-639-9544",
            "fax_number": "801-263-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-10",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "9428093-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Dallas Whyms
• Catherine Wick, PHARMD
• Emily Anne Wickenkamp, OT
• Emily Ann Wickens
• Kerrie Lyn Wickersham
• Kerry Wickman, LCSW
• Alyssa Widener
• Kristina Wieder
• Susan Elizabeth Wiedmeier
• Jennifer Wiegand

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; 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.