Healthcare Provider Details

I. General information

NPI: 1407439854
Provider Name (Legal Business Name): MARIANNA ISABELLE BOULTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANNA ISABELLE STRASZ

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W SOUTH ST
HASTINGS MI
49058-2257
US

IV. Provider business mailing address

1040 S WINTER ST STE 1022
ADRIAN MI
49221-3867
US

V. Phone/Fax

Practice location:
  • Phone: 734-657-9987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: