MEDICARE: DONNA JANE GENYK 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
1	1041C0700X	Clinical Social Worker	6801079752	MI

General Provider Information

NPI Number	:	1134644628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA JANE GENYK MSW

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MI
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3399 E GRAND RIVER AVE STE 202
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-7555
Country	:	US
Telephone Number	:	517-548-1020
Fax Number	:

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	09/25/2017

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