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General NPI Number Information
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NPI Number | 1962553453
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Entity Type | Organization
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Legal Business Name | CEDAR TREE
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 403 E MICHIGAN ST
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City | MARQUETTE
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State | MI
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Zip | 49855-3827
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Country | US
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Telephone | 906-228-5494
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Fax | 906-228-5494
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Provider Business Mailing Address
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Address Line | 403 E MICHIGAN ST
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City | MARQUETTE
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State | MI
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Zip | 49855-3827
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Country | US
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Telephone | 906-228-5494
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Fax | 906-228-5494
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Authorized Official
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Title or Position | DIRECTOR
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Name | JON WILLIAM MAGNUSON
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Credential | MSW ACSW
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Telephone | 906-228-5494
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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 | 6801070289
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License Number State | MI
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