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General NPI Number Information
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NPI Number | 1942839238
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Entity Type | Organization
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Legal Business Name | PATRICIA HICKEY MSW
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 2020 RAYBROOK ST SE STE 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7717
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Country | US
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Telephone | 616-560-3199
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Fax | 616-777-0406
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Provider Business Mailing Address
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Address Line | 2020 RAYBROOK ST SE STE 301
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7717
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Country | US
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Telephone | 616-560-3199
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Fax | 616-777-0406
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA ANN HICKEY
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Credential | MSW
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Telephone | 616-560-3199
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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 |
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License Number State |
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