Healthcare Provider Details

I. General information

NPI: 1922699305
Provider Name (Legal Business Name): MRS. JUDITH HAUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24630 SUSSEX ST
OAK PARK MI
48237-1539
US

IV. Provider business mailing address

24630 SUSSEX ST
OAK PARK MI
48237-1539
US

V. Phone/Fax

Practice location:
  • Phone: 248-376-3419
  • Fax:
Mailing address:
  • Phone: 248-376-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: