Healthcare Provider Details

I. General information

NPI: 1528889037
Provider Name (Legal Business Name): JENNA KRISTINE SIK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4832 NIGHT HERDER
SAINT HEDWIG TX
78152-0380
US

IV. Provider business mailing address

4832 NIGHT HERDER
SAINT HEDWIG TX
78152-0380
US

V. Phone/Fax

Practice location:
  • Phone: 612-987-2697
  • Fax:
Mailing address:
  • Phone: 612-987-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: