Provider Demographics
NPI:1386318384
Name:HASENICK, MELINDA SUE (LCSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:HASENICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:SUE
Other - Last Name:SIERADSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6801 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-9407
Mailing Address - Country:US
Mailing Address - Phone:269-274-4288
Mailing Address - Fax:
Practice Address - Street 1:290 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8427
Practice Address - Country:US
Practice Address - Phone:269-888-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011059471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical