MEDICARE: MRS. ALISON SARA KOO ANDRUS-GALLIWAY MA

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	101YP2500X	Professional Counselor	6401013498	MI

General Provider Information

NPI Number	:	1578996484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON SARA KOO ANDRUS-GALLIWAY MA

Provider Business Mailing Address
First Line	:	328 W MARYKNOLL RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1942
Country	:	US
Telephone Number	:	248-872-2841
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 W MARYKNOLL RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1942
Country	:	US
Telephone Number	:	248-872-2841
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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