Healthcare Provider Details

I. General information

NPI: 1285653352
Provider Name (Legal Business Name): DEBRA L WURDOCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CENTER AVE
BAY CITY MI
48708-6110
US

IV. Provider business mailing address

1420 CENTER AVE
BAY CITY MI
48708-6110
US

V. Phone/Fax

Practice location:
  • Phone: 989-892-2504
  • Fax: 989-894-4704
Mailing address:
  • Phone: 989-892-2504
  • Fax: 989-894-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: