MEDICARE: MICHELLE TRUDELL LMSW

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	104100000X	Social Worker	6801087718	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7509105760	OTHER	MI	BCBS
2	20636	OTHER	MI	BCBS SA

General Provider Information

NPI Number	:	1114967783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE TRUDELL LMSW

Provider Business Mailing Address
First Line	:	4771 2 MILE RD
Second Line	:	SUITE A
City	:	BAY CITY
State	:	MI
Zip	:	48706-2775
Country	:	US
Telephone Number	:	989-778-2323
Fax Number	:	989-778-2322

Provider Business Practice Location Address
First Line	:	4771 2 MILE RD
Second Line	:	SUITE A
City	:	BAY CITY
State	:	MI
Zip	:	48706-2775
Country	:	US
Telephone Number	:	989-778-2323
Fax Number	:	989-778-2322

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/12/2016

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Directions to “ MICHELLE TRUDELL LMSW” Practice Location

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