Healthcare Provider Details

I. General information

NPI: 1497804025
Provider Name (Legal Business Name): ALISON YACOBOZZI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 SHIP ST FL 2
SAINT JOSEPH MI
49085-1171
US

IV. Provider business mailing address

811 SHIP ST
SAINT JOSEPH MI
49085-1171
US

V. Phone/Fax

Practice location:
  • Phone: 269-408-8013
  • Fax:
Mailing address:
  • Phone: 269-408-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801064468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: