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NPI Code Detail

MEDICARE: CHARLENE THIEDE LMSW

MEDICARE: CHARLENE THIEDE 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1427406149
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLENE THIEDE LMSW
Provider Business Mailing Address
First Line : 2945 E WEST MAPLE RD SUITE D407
Second Line :
City : COMMERCE TOWNSHIP
State : MI
Zip : 48390-3801
Country : US
Telephone Number : 248-624-3812
Fax Number :
Provider Business Practice Location Address
First Line : 2945 E WEST MAPLE RD SUITE D407
Second Line :
City : COMMERCE TOWNSHIP
State : MI
Zip : 48390-3801
Country : US
Telephone Number : 248-624-3812
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2016
Last Update Date : 06/03/2016

Similar Medicare Providers

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Practice Location Address:
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Practice Fax: 248-668-0924

Directions to “ CHARLENE THIEDE LMSW” Practice Location

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