Healthcare Provider Details

I. General information

NPI: 1811807720
Provider Name (Legal Business Name): JOANNE LYNN POLFUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 3RD AVE S
ESCANABA MI
49829-1258
US

IV. Provider business mailing address

N12533 POLFUS ROAD E 3
CARNEY MI
49812-9476
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-9300
  • Fax:
Mailing address:
  • Phone: 989-640-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801085831
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: