Active NPI
Maegan Wickstrom, LLMSW
- Clinical Social Worker
- Manistique, MI
National Provider Identifier
1497363063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 5698W US Highway 2
Manistique, MI 49854-9116 - Phone
- (906) 632-5272
- NPI assigned
- Jul 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
5698W US Highway 2
Manistique, MI 49854-9116
Mailing address
5698W US Highway 2
Manistique, MI 49854-9116
Phone (906) 632-5272
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595203200000",
"number": "1497363063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5698W US HIGHWAY 2",
"city": "MANISTIQUE",
"state": "MI",
"postal_code": "498549116",
"telephone_number": "906-632-5272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5698W US HIGHWAY 2",
"city": "MANISTIQUE",
"state": "MI",
"postal_code": "498549116",
"telephone_number": "906-632-5272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKSTROM",
"first_name": "MAEGAN",
"credential": "LLMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-20",
"last_updated": "2020-07-20",
"certification_date": "2020-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manistique, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.