MS. Holly D Wickenhauser, ATC
NPI #1659546422 in Bloomington, Illinois
Provider Information
- NPI Number
- 1659546422
- Entity Type
- Individual
- Name
- MS. Holly D Wickenhauser, ATC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Specialist/Technologist - Athletic Trainer
- Credential
- ATC
- Enumeration Date
- Apr 23, 2008
- Last Updated
- Jan 4, 2017
Practice Location
- Address
- 1111 TRINITY LN
- Address 2
- SUITE 111
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-8111
- Phone
- (309) 663-6461
Specialties & Taxonomy Codes
| Specialty |
|---|
| Specialist/Technologist - Athletic Trainer — Athletic Trainer |
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