JONATHAN WICKS ATC LAT M.ED NPI 1003341918

NPI Information

NPI: 1003341918
Provider Name: JONATHAN WICKS, ATC, LAT, M.ED
Classification: Psychiatry & Neurology - 2084S0010X
Entity Type: Individual

Specialization: Sports Medicine

Address:
1001 E 17TH ST
BLOOMINGTON, IN
ZIP 47408
Phone: (812) 855-7920
Get Directions

Jonathan Wicks, ATC, LAT, M.ED is a sports medicine psychiatry neurology in Bloomington, IN. The provider is a psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries. Jonathan Wicks, ATC, LAT, M.ED NPI is 1003341918. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1001 E 17TH ST
BLOOMINGTON, IN
ZIP 47408-590
Phone: (812) 855-7920

The enumeration date for this NPI number is 4/28/2017 and was last updated on 4/28/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084S0010X	Psychiatry & Neurology	Sports Medicine	36002506A	INDIANA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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