Healthcare Provider Details

I. General information

NPI: 1285021253
Provider Name (Legal Business Name): RHONDA LYNN DENNIS LMSW, SSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 N 1ST ST
HARBOR BEACH MI
48441-1101
US

IV. Provider business mailing address

136 N 1ST ST
HARBOR BEACH MI
48441-1101
US

V. Phone/Fax

Practice location:
  • Phone: 989-479-3101
  • Fax: 989-479-3529
Mailing address:
  • Phone: 989-479-3101
  • Fax: 989-479-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: