Healthcare Provider Details

I. General information

NPI: 1548600786
Provider Name (Legal Business Name): HEATHER M MILLIKEN M.S.W., CAADC, SAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E GRAND RIVER AVE STE 1
BRIGHTON MI
48116-1820
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 810-599-9591
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088782
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: