Healthcare Provider Details

I. General information

NPI: 1457662462
Provider Name (Legal Business Name): TONYA M HANSELMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 S VAN DYKE RD
BAD AXE MI
48413-9615
US

IV. Provider business mailing address

4579 GARFIELD ST
UBLY MI
48475-7716
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9293
  • Fax:
Mailing address:
  • Phone: 989-553-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088321
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: