MEDICARE: DONNA RICHARDSON L.M.S.W.

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	6801078233	MI

General Provider Information

NPI Number	:	1952725137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA RICHARDSON L.M.S.W.

Provider Business Mailing Address
First Line	:	4431 N LAKE RD
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234-9694
Country	:	US
Telephone Number	:	517-917-2564
Fax Number	:

Provider Business Practice Location Address
First Line	:	4431 N LAKE RD
Second Line	:
City	:	CLARKLAKE
State	:	MI
Zip	:	49234-9694
Country	:	US
Telephone Number	:	517-917-2564
Fax Number	:

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

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	02/10/2014

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Directions to “ DONNA RICHARDSON L.M.S.W.” Practice Location

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