Provider Demographics
NPI:1518052414
Name:SICKLER, TERRY A (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:SICKLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 NW MEDICAL LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-5597
Mailing Address - Country:US
Mailing Address - Phone:541-440-3532
Mailing Address - Fax:541-677-5815
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1281
Practice Address - Country:US
Practice Address - Phone:541-440-3532
Practice Address - Fax:541-677-5815
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL14831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500619623Medicaid
OR500619623Medicaid