Healthcare Provider Details

I. General information

NPI: 1356829501
Provider Name (Legal Business Name): CHRISTINE CROMWELL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE KOEHLER

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2354 S GRAY RD
WEST BRANCH MI
48661-9606
US

IV. Provider business mailing address

2354 S GRAY RD
WEST BRANCH MI
48661-9606
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8636
  • Fax:
Mailing address:
  • Phone: 989-390-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802070707
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801111012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: