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General NPI Number Information
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NPI Number | 1386318384
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Entity Type | Individual
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Provider Name | MELINDA SUE HASENICK LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 290 B DR N
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City | ALBION
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State | MI
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Zip | 49224-8427
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Country | US
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Telephone | 269-888-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 23 MILE RD
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City | HOMER
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State | MI
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Zip | 49245-9407
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Country | US
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Telephone | 269-274-4288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801105947
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License Number State | MI
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