MEDICARE: CANDY STRAUBEL-SOWER LLC

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	6801090806	MI

General Provider Information

NPI Number	:	1639517840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANDY STRAUBEL-SOWER LLC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:	517-676-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 W MAIN ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-1639
Country	:	US
Telephone Number	:	616-523-6537
Fax Number	:	616-523-6536

Authorized Official
Title or Position	:	OWNER
Name	:	CANDY L STRAUBEL-SOWER
Credential	:	LMSW
Telephone Number	:	616-523-6537

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	07/31/2016

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