Healthcare Provider Details

I. General information

NPI: 1821329806
Provider Name (Legal Business Name): JUDY IRENE MCLANE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W SAGINAW ST
LANSING MI
48915-1927
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-7700
  • Fax: 517-364-7701
Mailing address:
  • Phone: 517-364-7700
  • Fax: 517-364-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801014594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: