Healthcare Provider Details

I. General information

NPI: 1255729646
Provider Name (Legal Business Name): ANNA SOO JUNG NORRIS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 CHARTWELL DR
TRAVERSE CITY MI
49696-9283
US

IV. Provider business mailing address

1810 CHARTWELL DR
TRAVERSE CITY MI
49696-9283
US

V. Phone/Fax

Practice location:
  • Phone: 231-929-2354
  • Fax:
Mailing address:
  • Phone: 231-929-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: