MEDICARE: SCOTT GANTZ LLMSW

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	6801099587	MI

General Provider Information

NPI Number	:	1174954101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT GANTZ LLMSW

Provider Business Mailing Address
First Line	:	522 S MAPLE RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3837
Country	:	US
Telephone Number	:	734-585-7970
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 S MAPLE RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3837
Country	:	US
Telephone Number	:	734-585-7970
Fax Number	:

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

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	02/16/2017

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Directions to “ SCOTT GANTZ LLMSW” Practice Location

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