Provider Demographics
NPI:1386702645
Name:HICKMAN, MARLENE ANN (MSW LMSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 DUBLIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8533
Mailing Address - Country:US
Mailing Address - Phone:989-633-3721
Mailing Address - Fax:989-633-3704
Practice Address - Street 1:4700 DUBLIN AVENUE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8533
Practice Address - Country:US
Practice Address - Phone:989-633-3721
Practice Address - Fax:989-633-3704
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL7868531041C0700X
MIL617933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist