Healthcare Provider Details

I. General information

NPI: 1215129804
Provider Name (Legal Business Name): ROBERT PAUL WICKENHEISER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 HARRISON ST
MONROE MI
48161-4018
US

IV. Provider business mailing address

1006 HARRISON ST
MONROE MI
48161-4018
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-2546
  • Fax:
Mailing address:
  • Phone: 734-241-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801001914
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: