MEDICARE: MS. LISA MARIE KESKITALO LMSW

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	6801087390	MI

General Provider Information

NPI Number	:	1598932998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE KESKITALO LMSW

Provider Business Mailing Address
First Line	:	4414 CREEK VIEW DR
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-1921
Country	:	US
Telephone Number	:	616-690-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	3672 CHICAGO DR
Second Line	:	SUITE A
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-2601
Country	:	US
Telephone Number	:	616-690-2159
Fax Number	:

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

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	02/11/2017

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