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General NPI Number Information
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NPI Number | 1801337787
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Entity Type | Individual
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Provider Name | GEORGE J WESSEL I LMSW
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Gender | Male
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 612 SHERMAN OAKS DR
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City | LUDINGTON
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State | MI
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Zip | 49431-2325
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Country | US
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Telephone | 231-690-9742
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Fax | 231-421-7147
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Provider Business Mailing Address
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Address Line | 612 SHERMAN OAKS DR
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City | LUDINGTON
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State | MI
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Zip | 49431-2325
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Country | US
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Telephone | 231-425-4036
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Fax | 231-425-4036
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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 | 6801097028
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License Number State | MI
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