Healthcare Provider Details

I. General information

NPI: 1265858302
Provider Name (Legal Business Name): WANDA GEORGEANN BEBOW RSST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WRIGHT AVE
ALMA MI
48801-1617
US

IV. Provider business mailing address

608 WRIGHT AVE
ALMA MI
48801-1617
US

V. Phone/Fax

Practice location:
  • Phone: 989-968-4026
  • Fax:
Mailing address:
  • Phone: 989-968-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803074642
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: