MEDICARE: RAMONA SUE WRIGHT L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401007429	MI
2	104100000X	Social Worker	6802083345	MI

General Provider Information

NPI Number	:	1063650414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA SUE WRIGHT L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 24
Second Line	:	11737 ONONDAGA RD
City	:	ONONDAGA
State	:	MI
Zip	:	49264-0024
Country	:	US
Telephone Number	:	517-262-0571
Fax Number	:	888-904-2399

Provider Business Practice Location Address
First Line	:	209 E WASHINGTON AVE
Second Line	:	SUITE 219 BOX 6
City	:	JACKSON
State	:	MI
Zip	:	49201-2393
Country	:	US
Telephone Number	:	517-262-0571
Fax Number	:	866-904-2399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	01/22/2009

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