Most Relevant Information
Provider Data
| NPI Number: | 1003592817 |
| Provider Name: | KEVIN WICKLINE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/26/2023 |
| Last Updated: | 06/26/2023 |
Provider Practice Location
1451 LUCAS ROAD
MANSFIELD
OH
449038682
Practice Location Phone/Fax
| Phone: | 4195895511 |
| Fax: |
Provider Mailing Location
1451 LUCAS ROAD
MANSFIELD
OH
449038682
Provider Mailing Phone/Fax
| Phone: | 4195895511 |
| Fax: |