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General NPI Number Information
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NPI Number | 1366871899
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Entity Type | Individual
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Provider Name | AMY ROULEAU LLBSW
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Gender | Female
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 585 JEWETT RD
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City | MASON
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State | MI
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Zip | 48854-8729
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Country | US
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Telephone | 517-676-5405
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BROOKFIELD
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-1295
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Country | US
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Telephone | 517-676-5405
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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 | 6802087870
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License Number State | MI
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