Provider Demographics
NPI:1114951829
Name:TIKKANEN, PATRICIA J (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:TIKKANEN
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 1:200 MICHIGAN ST STE 321
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1448
Mailing Address - Country:US
Mailing Address - Phone:906-369-5722
Mailing Address - Fax:906-323-4212
Practice Address - Street 1:200 MICHIGAN ST STE 321
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930
Practice Address - Country:US
Practice Address - Phone:906-369-5722
Practice Address - Fax:906-323-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker