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NPI Code Detail

MEDICARE: LAURIE JEAN WHEAR LBSW

MEDICARE: LAURIE JEAN WHEAR LBSW
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 Worker6802058739MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LW058739OTHERMIBCBS OF MI

General Provider Information

NPI Number : 1447281209
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE JEAN WHEAR LBSW
Provider Business Mailing Address
First Line : 715 PYLE DR
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-4456
Country : US
Telephone Number : 906-774-0522
Fax Number : 906-774-1570
Provider Business Practice Location Address
First Line : 703 N 2ND AVE
Second Line :
City : IRON RIVER
State : MI
Zip : 49935-1451
Country : US
Telephone Number : 906-265-5126
Fax Number : 906-265-5878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 07/08/2007

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Directions to “ LAURIE JEAN WHEAR LBSW” Practice Location

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