Healthcare Provider Details

I. General information

NPI: 1811083413
Provider Name (Legal Business Name): ANN ELIINA MUNTTER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 HOLIDAY TERRACE CFPS
KALAMAZOO MI
49009
US

IV. Provider business mailing address

5340 HOLIDAY TERRACE CFPS
KALAMAZOO MI
49009
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-4140
  • Fax: 269-372-0390
Mailing address:
  • Phone: 269-372-4140
  • Fax: 269-372-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801020352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: