MEDICARE: MRS. VONETTA RESHAN MCGINNIS MSW

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	6801088738	MI

General Provider Information

NPI Number	:	1750539037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VONETTA RESHAN MCGINNIS MSW

Provider Business Mailing Address
First Line	:	185 E MAIN ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4431
Country	:	US
Telephone Number	:	269-925-8222
Fax Number	:	269-925-8354

Provider Business Practice Location Address
First Line	:	185 E MAIN ST
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4431
Country	:	US
Telephone Number	:	269-925-8222
Fax Number	:	269-925-8354

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

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	02/15/2012

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