MEDICARE: ELAINE TERESE PLOTZKE LMSW, ACSW

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	6801063049	MI

General Provider Information

NPI Number	:	1487358164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE TERESE PLOTZKE LMSW, ACSW

Provider Business Mailing Address
First Line	:	37899 W 12 MILE RD STE 250
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-6107
Country	:	US
Telephone Number	:	248-921-4614
Fax Number	:

Provider Business Practice Location Address
First Line	:	37899 W 12 MILE RD STE 250
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-6107
Country	:	US
Telephone Number	:	248-921-4614
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	06/20/2023

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