MEDICARE: MEGAN VANSICKLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6801083402	MI
2	1041C0700X	Clinical Social Worker	6801083402	MI

General Provider Information

NPI Number	:	1164240990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN VANSICKLE

Provider Business Mailing Address
First Line	:	2559 UNION LAKE RD
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3555
Country	:	US
Telephone Number	:	248-404-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2559 UNION LAKE RD
Second Line	:
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48382-3555
Country	:	US
Telephone Number	:	248-404-8555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	06/18/2025

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Directions to “ MEGAN VANSICKLE ” Practice Location

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