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NPI Code Detail

MEDICARE: MRS. JENNIFER LYNN GANSHORN LMSW

MEDICARE: MRS. JENNIFER LYNN GANSHORN LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1215366794
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LYNN GANSHORN LMSW
Provider Business Mailing Address
First Line : 343 S MAIN ST STE 211
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-2138
Country : US
Telephone Number : 734-412-7400
Fax Number :
Provider Business Practice Location Address
First Line : 343 S MAIN ST STE 211
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-2138
Country : US
Telephone Number : 734-412-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2013
Last Update Date : 11/05/2020

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