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General NPI Number Information
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NPI Number | 1174808539
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Entity Type | Individual
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Provider Name | MARI PRUKS L.M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 2723 S. STATE STREET SUITE 150
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City | ANN ARBOR
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State | MI
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Zip | 48104-6188
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Country | US
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Telephone | 734-330-8932
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Fax |
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Provider Business Mailing Address
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Address Line | 2676 ASPEN RIDGE DRIVE
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City | ANN ARBOR
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State | MI
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Zip | 48105-8927
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Country | US
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Telephone | 734-352-0637
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090128
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License Number State | MI
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