Healthcare Provider Details

I. General information

NPI: 1396140281
Provider Name (Legal Business Name): MELISSA RYCKMAN LLMSW, RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 PROFESSIONAL DR SUITE D4
FLINT MI
48532-3636
US

IV. Provider business mailing address

1063 PROFESSIONAL DR SUITE D4
FLINT MI
48532-3636
US

V. Phone/Fax

Practice location:
  • Phone: 810-496-4937
  • Fax:
Mailing address:
  • Phone: 810-496-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680109748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: