Healthcare Provider Details

I. General information

NPI: 1437370491
Provider Name (Legal Business Name): DIANNE D TYNDALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TOWNE CENTRE RD STE 300
SAGINAW MI
48604-2841
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 989-498-5100
  • Fax: 989-498-0197
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801064849
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: