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NPI Code Detail

MEDICARE: MICHELE J GUSTAFSON LMSW

MEDICARE: MICHELE J GUSTAFSON 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 Worker6801018984MI

General Provider Information

NPI Number : 1437261948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE J GUSTAFSON LMSW
Provider Business Mailing Address
First Line : 5445 ALI DR DEPT 320
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-5193
Country : US
Telephone Number : 810-428-1181
Fax Number :
Provider Business Practice Location Address
First Line : 5445 ALI DR DEPT 320
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-5193
Country : US
Telephone Number : 810-428-1181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 11/02/2023

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Directions to “ MICHELE J GUSTAFSON LMSW” Practice Location

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