Provider Demographics
NPI:1912172669
Name:WYCKLENDT, CLAIRE M (PT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:M
Last Name:WYCKLENDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 N WOODBURN ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1554
Mailing Address - Country:US
Mailing Address - Phone:414-962-4757
Mailing Address - Fax:
Practice Address - Street 1:8949 N. DEERBROOK TR
Practice Address - Street 2:HORIZON HOME CARE AND HOSPICE INC
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-9714
Practice Address - Country:US
Practice Address - Phone:414-586-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1910-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40102500Medicaid