Healthcare Provider Details

I. General information

NPI: 1922032168
Provider Name (Legal Business Name): JEAN ANGEL KUPPER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
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

2820 COLLEGE AVE
ESCANABA MI
49829-9591
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 Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083844
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: