MEDICARE: SARAH LICKISS LMSW

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	1041C0700X	Clinical Social Worker
2	104100000X	Social Worker	6801094001	MI

General Provider Information

NPI Number	:	1497953434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LICKISS LMSW

Provider Business Mailing Address
First Line	:	600 3 MILE RD NW STE 101
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-1691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 3 MILE RD NW STE 101
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-1691
Country	:	US
Telephone Number	:	616-287-3497
Fax Number	:

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	09/17/2024

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Directions to “ SARAH LICKISS LMSW” Practice Location

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