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General NPI Number Information
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NPI Number | 1609433168
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Entity Type | Individual
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Provider Name | TASHA LEEANN CONRAD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 13101 ALLEN RD BLDG 4
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City | SOUTHGATE
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State | MI
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Zip | 48195-2216
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Country | US
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Telephone | 734-785-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 6077 BUNKER HILL ST
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City | FLINT
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State | MI
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Zip | 48506-1679
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Country | US
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Telephone | 810-516-9092
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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