Healthcare Provider Details

I. General information

NPI: 1407099914
Provider Name (Legal Business Name): TAMMY M OBRIEN-ALLEN LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY M SCHNEIDERHAN-OBRIEN LBSW

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1236
  • Fax: 906-233-1235
Mailing address:
  • Phone: 906-233-1236
  • Fax: 906-233-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801068117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: