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NPI Code Detail

MEDICARE: CAROL EVELYN FRISKE BANKS LBSW

MEDICARE: CAROL EVELYN FRISKE BANKS LBSW
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
1104100000XSocial Worker6802066969MI

General Provider Information

NPI Number : 1114533189
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL EVELYN FRISKE BANKS LBSW
Provider Business Mailing Address
First Line : PO BOX 800
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48804-0800
Country : US
Telephone Number : 989-773-6904
Fax Number : 989-772-5339
Provider Business Practice Location Address
First Line : 107 E ILLINOIS ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-2503
Country : US
Telephone Number : 989-773-6904
Fax Number : 989-772-5339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2020
Last Update Date : 09/16/2020

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