Provider Demographics
NPI:1114394467
Name:PENICK, ANDREA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PENICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9538
Mailing Address - Country:US
Mailing Address - Phone:773-218-5507
Mailing Address - Fax:
Practice Address - Street 1:2 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3609
Practice Address - Country:US
Practice Address - Phone:269-532-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010985271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical