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General NPI Number Information
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NPI Number | 1780986752
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Entity Type | Organization
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Legal Business Name | CREPS MEDICAL INCORPORATED
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1064 KENDALE PL
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City | SAGINAW
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State | MI
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Zip | 48609-6792
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Country | US
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Telephone | 989-607-6003
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Fax |
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Provider Business Mailing Address
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Address Line | 3061 CHRISTY WAY
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City | SAGINAW
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State | MI
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Zip | 48603-2224
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Country | US
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Telephone | 989-791-2455
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Fax | 989-791-1392
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Authorized Official
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Title or Position | CEO
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Name | KELLIE SWARTZ
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Credential | PROFESSIONAL MEDICAL
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Telephone | 989-791-2455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 5101011298
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License Number State | MI
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