MEDICARE: KATE MARIE ERMUTLU

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	1041C0700X	Clinical Social Worker	6801110696	MI

General Provider Information

NPI Number	:	1477290583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE MARIE ERMUTLU

Provider Business Mailing Address
First Line	:	PO BOX 13008
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48901-3008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 HYLAND DR
Second Line	:
City	:	PORTLAND
State	:	MI
Zip	:	48875-8508
Country	:	US
Telephone Number	:	517-253-5084
Fax Number	:

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

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	10/15/2024

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