MEDICARE: CAMILLA ARNTZEN SKILL 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	1041C0700X	Clinical Social Worker	6801097369	MI

General Provider Information

NPI Number	:	1134750250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLA ARNTZEN SKILL LMSW

Provider Business Mailing Address
First Line	:	23736 COUZENS AVE
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1512
Country	:	US
Telephone Number	:	734-276-6082
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 COLLINGWOOD ST STE 140
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3842
Country	:	US
Telephone Number	:	734-274-0536
Fax Number	:

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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