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NPI Code Detail

MEDICARE: MRS. THERESA PYLAH GARDINER BASW

MEDICARE: MRS. THERESA PYLAH GARDINER BASW
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 Worker6802085632MI

General Provider Information

NPI Number : 1598882540
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA PYLAH GARDINER BASW
Provider Business Mailing Address
First Line : 1423 FIELD ST
Second Line :
City : DETROIT
State : MI
Zip : 48214-2321
Country : US
Telephone Number : 313-924-7860
Fax Number : 313-924-0350
Provider Business Practice Location Address
First Line : 1423 FIELD ST
Second Line :
City : DETROIT
State : MI
Zip : 48214-2321
Country : US
Telephone Number : 313-924-7860
Fax Number : 313-924-0350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. THERESA PYLAH GARDINER BASW” Practice Location

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