MEDICARE: JAN CAMILLE BAILEY 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
1	104100000X	Social Worker	6801091840	MI

General Provider Information

NPI Number	:	1750786711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAN CAMILLE BAILEY LMSW

Provider Business Mailing Address
First Line	:	1575 N EAST SILVER LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-8030
Country	:	US
Telephone Number	:	231-313-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 N EAST SILVER LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-8030
Country	:	US
Telephone Number	:	231-313-1503
Fax Number	:

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

Provider Enumeration Date	:	11/01/2014
Last Update Date	:	11/01/2014

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