MEDICARE: MICHELLE EGGENBERGER

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
1	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801072907	OTHER	MI	SOCIAL WORKER LICENSE

General Provider Information

NPI Number	:	1255056669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE EGGENBERGER

Provider Business Mailing Address
First Line	:	36602 VICARY LN
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48335-2944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	36602 VICARY LN
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48335-2944
Country	:	US
Telephone Number	:	248-417-0852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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Directions to “ MICHELLE EGGENBERGER ” Practice Location

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