Provider Demographics
NPI:1073901666
Name:WICHMANN, MARSHA (MS)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:
Last Name:WICHMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CENTER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1972
Mailing Address - Country:US
Mailing Address - Phone:182-366-6162
Mailing Address - Fax:
Practice Address - Street 1:725 CENTER AVE STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1972
Practice Address - Country:US
Practice Address - Phone:218-366-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1735101YA0400X
MN306949101YA0400X
MN03124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)