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NPI Code Detail

MEDICARE: MS. JENNIFER LITZENBERG MS, ATC

MEDICARE: MS. JENNIFER LITZENBERG MS, ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1598811614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER LITZENBERG MS, ATC
Provider Business Mailing Address
First Line : 35418 TIMBERWOOD CT
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-2158
Country : US
Telephone Number : 260-410-0782
Fax Number :
Provider Business Practice Location Address
First Line : 26755 BALLARD ST
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-2419
Country : US
Telephone Number : 586-466-5234
Fax Number : 586-466-5397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 07/08/2007

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