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NPI Code Detail

MEDICARE: CRYSTA RANSOM-SOPER LMSW

MEDICARE: CRYSTA RANSOM-SOPER 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 Worker130375WI
21041C0700XClinical Social Worker
31041C0700XClinical Social Worker6801099965MI

General Provider Information

NPI Number : 1447797212
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTA RANSOM-SOPER LMSW
Provider Business Mailing Address
First Line : 138 HARTSHORN ST
Second Line :
City : BAD AXE
State : MI
Zip : 48413-1358
Country : US
Telephone Number : 810-310-0854
Fax Number :
Provider Business Practice Location Address
First Line : 6627 ROSE ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1262
Country : US
Telephone Number : 989-872-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2017
Last Update Date : 04/09/2024

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Directions to “ CRYSTA RANSOM-SOPER LMSW” Practice Location

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