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NPI Code Detail

MEDICARE: MRS. MARY FRANCES DIEPSTRA MSW

MEDICARE: MRS. MARY FRANCES DIEPSTRA MSW
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
11041C0700XClinical Social Worker6801084430MI

General Provider Information

NPI Number : 1124170543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY FRANCES DIEPSTRA MSW
Provider Business Mailing Address
First Line : 301 S CRAPO ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-2941
Country : US
Telephone Number : 989-772-5938
Fax Number :
Provider Business Practice Location Address
First Line : 301 S CRAPO ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-2941
Country : US
Telephone Number : 989-772-5938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/08/2007

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