Healthcare Provider Details

I. General information

NPI: 1881053254
Provider Name (Legal Business Name): AUTUMN FICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBEIN BLVD CHILDREN'S HOSPITAL OF MI
DETROIT MI
48306
US

IV. Provider business mailing address

3901 BEAUBIEN BLVD CHILDREN'S HOSPITAL OF MI-SOCIAL WORK
DETROIT MI
48201-3722
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-0187
  • Fax:
Mailing address:
  • Phone: 313-745-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: