Provider Demographics
NPI:1962624957
Name:HICKMOTT, KERI SUE (MSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:SUE
Last Name:HICKMOTT
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 1:707 ROLLING ACRES DR.
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:48462-9152
Mailing Address - Country:US
Mailing Address - Phone:248-627-1457
Mailing Address - Fax:
Practice Address - Street 1:9340 DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348
Practice Address - Country:US
Practice Address - Phone:248-625-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL8671631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical