Healthcare Provider Details

I. General information

NPI: 1669130910
Provider Name (Legal Business Name): STEPHANIE DANIELLE WICKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DANIELLE DOSSER LMSW

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 E MILLER RD
LANSING MI
48911-5348
US

IV. Provider business mailing address

13120 OLD HICKORY TRL
DEWITT MI
48820-9633
US

V. Phone/Fax

Practice location:
  • Phone: 517-319-0673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105420
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: