Individual
MEGAN HICKENBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
520 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-7958
Mailing address
3305 QUEENSLAND LN N, PLYMOUTH, MN 55447-1133
(612) 720-5632
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22369
MN
Other
Enumeration date
04/05/2019
Last updated
09/23/2024
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