Healthcare Provider Details

I. General information

NPI: 1255404539
Provider Name (Legal Business Name): SHARON LEA HENDRICKS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 S BENZONIA TRL
EMPIRE MI
49630-8503
US

IV. Provider business mailing address

12100 S BENZONIA TRL
EMPIRE MI
49630-8503
US

V. Phone/Fax

Practice location:
  • Phone: 231-409-2248
  • Fax: 231-326-3026
Mailing address:
  • Phone: 231-326-3002
  • Fax: 231-942-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801035572
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: