MEDICARE: JENNA KRISTINE SIK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	110613	TX

General Provider Information

NPI Number	:	1528889037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA KRISTINE SIK LCSW

Provider Business Mailing Address
First Line	:	4832 NIGHT HERDER
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-0380
Country	:	US
Telephone Number	:	612-987-2697
Fax Number	:

Provider Business Practice Location Address
First Line	:	4832 NIGHT HERDER
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-0380
Country	:	US
Telephone Number	:	612-987-2697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	08/15/2025

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