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General NPI Number Information
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NPI Number | 1952410847
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Entity Type | Individual
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Provider Name | CORY J VEDIN LMSW
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 333 S STEPHENSON AVE
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-2942
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Country | US
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Telephone | 906-235-2261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 842
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0842
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Country | US
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Telephone | 906-828-5118
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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 | 6801086739
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801086739
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License Number State | MI
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