Healthcare Provider Details

I. General information

NPI: 1659743904
Provider Name (Legal Business Name): LORELLE SCHNEIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

8623 N WAYNE RD
WESTLAND MI
48185-1137
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-0469
  • Fax:
Mailing address:
  • Phone: 734-367-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberD 565 546 572 770
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801104318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: