Healthcare Provider Details

I. General information

NPI: 1639456015
Provider Name (Legal Business Name): HEATHER ANNE NAWROCKI-COTE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HEATHER ANNE NAWROCKI

II. Dates (important events)

Enumeration Date: 11/13/2011
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W GATES ST
BRUCE TWP MI
48065-4494
US

IV. Provider business mailing address

124 W GATES ST
BRUCE TWP MI
48065-4494
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-9696
  • Fax:
Mailing address:
  • Phone: 586-752-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801093234
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: