Healthcare Provider Details

I. General information

NPI: 1689929176
Provider Name (Legal Business Name): DANA MCKENZIE-SIMMONS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 JANES AVE
SAGINAW MI
48601-1819
US

IV. Provider business mailing address

501 LAPEER AVE
SAGINAW MI
48607-1208
US

V. Phone/Fax

Practice location:
  • Phone: 989-755-0316
  • Fax: 989-755-0956
Mailing address:
  • Phone: 989-759-6464
  • Fax: 989-399-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093143
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: