Provider Demographics
NPI:1093548190
Name:WICKO, ALEKSANDRA
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:
Last Name:WICKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 KANE AVE
Mailing Address - Street 2:
Mailing Address - City:HODGKINS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6516 KANE AVE
Practice Address - Street 2:
Practice Address - City:HODGKINS
Practice Address - State:IL
Practice Address - Zip Code:60525-7618
Practice Address - Country:US
Practice Address - Phone:708-482-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist