Healthcare Provider Details

I. General information

NPI: 1699347633
Provider Name (Legal Business Name): BAILEY MARIE DESCHUTTER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 07/10/2021
Certification Date: 07/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 E 13 MILE RD STE 200
WARREN MI
48093-3093
US

IV. Provider business mailing address

12200 E 13 MILE RD STE 200
WARREN MI
48093-3093
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-1810
  • Fax: 586-573-2121
Mailing address:
  • Phone: 586-573-1810
  • Fax: 586-573-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801109685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: