Most Relevant Information
Provider Data
| NPI Number: | 1003365990 |
| Provider Name: | AURORA WICKSTROM |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/03/2016 |
| Last Updated: | 10/03/2016 |
Provider Practice Location
41320 NW LODGE RD
BANKS
OR
971067136
Practice Location Phone/Fax
| Phone: | 5038889013 |
| Fax: |
Provider Mailing Location
41320 NW LODGE RD
BANKS
OR
971067136
Provider Mailing Phone/Fax
| Phone: | 5038889013 |
| Fax: |