Healthcare Provider Details

I. General information

NPI: 1326711201
Provider Name (Legal Business Name): LISA KRIKKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N BRIDGE ST
SARANAC MI
48881-5102
US

IV. Provider business mailing address

3725 VELTE RD
WOODLAND MI
48897-9734
US

V. Phone/Fax

Practice location:
  • Phone: 616-642-6466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801065498
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801065498
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801065498
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: