MEDICARE: CAROLYN M EHNIS

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	6801084767	MI

General Provider Information

NPI Number	:	1164755302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLYN M EHNIS

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:	517-676-9788
Fax Number	:	517-676-3438

Provider Business Practice Location Address
First Line	:	1020 LONG BLVD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-6896
Country	:	US
Telephone Number	:	517-694-6188
Fax Number	:	517-694-8078

Authorized Official
Title or Position	:	OWNER
Name	:	CAROLYN M EHNIS
Credential	:	LMSW
Telephone Number	:	517-676-4683

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

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