MEDICARE: LAKESHORE THERAPY PLLC

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	1041C0700X	Clinical Social Worker	6801080601	MI

General Provider Information

NPI Number	:	1699180901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE THERAPY PLLC

Provider Business Mailing Address
First Line	:	51 AUSTIN ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1244
Country	:	US
Telephone Number	:	810-689-4846
Fax Number	:	810-958-1430

Provider Business Practice Location Address
First Line	:	51 AUSTIN ST
Second Line	:
City	:	SANDUSKY
State	:	MI
Zip	:	48471-1244
Country	:	US
Telephone Number	:	810-689-4846
Fax Number	:	810-958-1430

Authorized Official
Title or Position	:	OWNER, LAKESHORE THERAPY PLLC
Name	:	HELENA WITKOWSKI
Credential	:	LMSW, ACSW
Telephone Number	:	810-689-4846

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	11/01/2024

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