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NPI Code Detail

MEDICARE: MS. DEBRA GAYLE HENDREN LICENSED BACHELOR'S

MEDICARE: MS. DEBRA GAYLE HENDREN LICENSED BACHELOR'S
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
1104100000XSocial Worker6802076082MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16802076082OTHERMIBACHELOR'S SOCIAL WORKER LICENSE

General Provider Information

NPI Number : 1740771872
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBRA GAYLE HENDREN LICENSED BACHELOR'S
Provider Business Mailing Address
First Line : 825 PARK AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-2227
Country : US
Telephone Number : 248-320-9177
Fax Number :
Provider Business Practice Location Address
First Line : 570 KIRTS BLVD STE 231
Second Line :
City : TROY
State : MI
Zip : 48084-4156
Country : US
Telephone Number : 248-269-1309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2018
Last Update Date : 05/24/2018

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Directions to “ MS. DEBRA GAYLE HENDREN LICENSED BACHELOR'S” Practice Location

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