Healthcare Provider Details

I. General information

NPI: 1336267632
Provider Name (Legal Business Name): PATRICIA ANN DULKA LMSW ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N BROAD ST
ADRIAN MI
49221-2762
US

IV. Provider business mailing address

707 E SIENA HEIGHTS DR APT 7
ADRIAN MI
49221-1766
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-2191
  • Fax: 517-264-6080
Mailing address:
  • Phone: 517-266-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68010734334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: