=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548812266
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA MARGARET O'ROURKE LMSW, CAADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2019
-----------------------------------------------------
Last Update Date | 11/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13191 SCHAVEY RD STE 3
-----------------------------------------------------
City | DEWITT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48820-9036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-227-3344
-----------------------------------------------------
Fax | 517-669-9839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 W CASS ST
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48879-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-763-6973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801115314
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------