Healthcare Provider Details

I. General information

NPI: 1083942858
Provider Name (Legal Business Name): ROBERT JOHN HEJNA LSW, ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2009
Last Update Date: 12/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S STATE ST
ANN ARBOR MI
48104-6179
US

IV. Provider business mailing address

10916 BRAUN RD
MANCHESTER MI
48158-8202
US

V. Phone/Fax

Practice location:
  • Phone: 734-662-6300
  • Fax:
Mailing address:
  • Phone: 517-456-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801015435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: