Healthcare Provider Details

I. General information

NPI: 1376931733
Provider Name (Legal Business Name): GINA LAAJALA LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 S SAGINAW ST STE 1460
FLINT MI
48507-2664
US

IV. Provider business mailing address

585 JEWETT RD
MASON MI
48854-8729
US

V. Phone/Fax

Practice location:
  • Phone: 810-237-0799
  • Fax:
Mailing address:
  • Phone: 517-676-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6801097553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: