Provider Demographics
NPI:1376936708
Name:SICKMUND, BRANDI ROSE (LLMSW)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ROSE
Last Name:SICKMUND
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:ROSE
Other - Last Name:TENHOOPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12130 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-8985
Mailing Address - Country:US
Mailing Address - Phone:616-786-4140
Mailing Address - Fax:
Practice Address - Street 1:12130 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:WEST OLIVE
Practice Address - State:MI
Practice Address - Zip Code:49460-8985
Practice Address - Country:US
Practice Address - Phone:616-786-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088480104100000X
MI6851110625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker