Healthcare Provider Details

I. General information

NPI: 1073961025
Provider Name (Legal Business Name): ALANA GOTTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 STATE ST
ALGONAC MI
48001-1448
US

IV. Provider business mailing address

9385 FOLKERT RD
CLAY MI
48001-4332
US

V. Phone/Fax

Practice location:
  • Phone: 810-278-3707
  • Fax:
Mailing address:
  • Phone: 810-278-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: