Healthcare Provider Details

I. General information

NPI: 1538440169
Provider Name (Legal Business Name): HEATHER MICHELE KLICK LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 POYNTZ AVE
MANHATTAN KS
66502-4148
US

IV. Provider business mailing address

1623 POYNTZ AVE
MANHATTAN KS
66502-4148
US

V. Phone/Fax

Practice location:
  • Phone: 785-477-1525
  • Fax:
Mailing address:
  • Phone: 785-477-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06342
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: