Healthcare Provider Details

I. General information

NPI: 1861547481
Provider Name (Legal Business Name): VICKI LYNN PULA-JUREK L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 NORTH HALE ROAD
TWINING MI
48766-9793
US

IV. Provider business mailing address

1171 NORTH M-65
TWINING MI
48766
US

V. Phone/Fax

Practice location:
  • Phone: 989-867-4262
  • Fax: 989-867-4334
Mailing address:
  • Phone: 989-867-4262
  • Fax: 989-867-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801060141
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: