MEDICARE: MARGARET JEAN FEDDER LLPC

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	101YM0800X	Mental Health Counselor	6401016802	MI

General Provider Information

NPI Number	:	1235614363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET JEAN FEDDER LLPC

Provider Business Mailing Address
First Line	:	10140 E GRANDVIEW CT
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-5310
Country	:	US
Telephone Number	:	801-707-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	13561 S WEST BAY SHORE DR STE 306
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-6292
Country	:	US
Telephone Number	:	801-707-4220
Fax Number	:

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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