Healthcare Provider Details

I. General information

NPI: 1972072155
Provider Name (Legal Business Name): COURTNEY ANN PLAMONDON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2018
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4572 S HAGADORN RD
EAST LANSING MI
48823-5385
US

IV. Provider business mailing address

1115 N CAPITOL AVE
LANSING MI
48906-4826
US

V. Phone/Fax

Practice location:
  • Phone: 517-481-2133
  • Fax:
Mailing address:
  • Phone: 231-632-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095884
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: