Healthcare Provider Details

I. General information

NPI: 1083355895
Provider Name (Legal Business Name): ALISON MARY CALNAN CPRM, CPRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON MARY GRAHAM CPRM, CPRC

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax:
Mailing address:
  • Phone: 810-985-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: