Healthcare Provider Details

I. General information

NPI: 1639650906
Provider Name (Legal Business Name): LINDSEY NICOLE DAOUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHNSON ST
ALPENA MI
49707-1434
US

IV. Provider business mailing address

2459 LONG LAKE PARK RD
ALPENA MI
49707-8977
US

V. Phone/Fax

Practice location:
  • Phone: 989-464-8640
  • Fax:
Mailing address:
  • Phone: 989-464-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: