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General NPI Number Information
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NPI Number | 1366806887
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Entity Type | Individual
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Provider Name | JYOTISH WIERTELLA LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 512 SCHOOL SCHOOLCRAFT ROAD
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City | MARQUETTE
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State | MI
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Zip | 49855
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Country | US
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Telephone | 906-299-3208
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Fax | 906-257-6736
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Provider Business Mailing Address
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Address Line | 512 SCHOOLCRAFT RD
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City | MARQUETTE
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State | MI
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Zip | 49855-5243
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Country | US
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Telephone | 906-299-3208
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Fax | 906-257-6736
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802088919
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801117216
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License Number State | MI
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