MEDICARE: ERICA WINDLER BEATTIE LLMSW

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	6801108195	MI

General Provider Information

NPI Number	:	1821696790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA WINDLER BEATTIE LLMSW

Provider Business Mailing Address
First Line	:	228 MAPLEWOOD DR
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4745
Country	:	US
Telephone Number	:	336-501-5485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5123 W ST JOE HWY STE 103
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-323-4099
Fax Number	:

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

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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