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NPI Code Detail

MEDICARE: MADISON OTTJEPKA LMSW

MEDICARE: MADISON OTTJEPKA 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
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker6801119521MI

General Provider Information

NPI Number : 1770126955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON OTTJEPKA LMSW
Provider Business Mailing Address
First Line : 135 BROADWAY ST
Second Line :
City : MARINE CITY
State : MI
Zip : 48039-1607
Country : US
Telephone Number : 810-765-8539
Fax Number :
Provider Business Practice Location Address
First Line : 6221 KING RD
Second Line :
City : MARINE CITY
State : MI
Zip : 48039-1428
Country : US
Telephone Number : 810-765-8539
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2019
Last Update Date : 12/16/2024

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Directions to “ MADISON OTTJEPKA LMSW” Practice Location

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