Healthcare Provider Details

I. General information

NPI: 1326288481
Provider Name (Legal Business Name): STEPHANIE ANNE WEESIES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANNE VANNETT LLMSW

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N PARK ST STE A
MUSKEGON MI
49442-1722
US

IV. Provider business mailing address

2700 BAKER ST FL 3
MUSKEGON MI
49444-2157
US

V. Phone/Fax

Practice location:
  • Phone: 231-788-7600
  • Fax:
Mailing address:
  • Phone: 231-737-1335
  • Fax: 231-737-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: