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NPI Code Detail

MEDICARE: VANESSA LAKE LMSW

MEDICARE:   VANESSA  LAKE  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
1104100000XSocial Worker6801099525MI

General Provider Information

NPI Number : 1326530056
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA LAKE LMSW
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3815 W SAINT JOSEPH ST STE B500B
Second Line :
City : LANSING
State : MI
Zip : 48917-5609
Country : US
Telephone Number : 616-303-1434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2018
Last Update Date : 04/20/2021

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Directions to “ VANESSA LAKE LMSW” Practice Location

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