MEDICARE: BRIEANNE KOVACH 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	6851116768	MI

General Provider Information

NPI Number	:	1821772351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIEANNE KOVACH LLMSW

Provider Business Mailing Address
First Line	:	207 N FRANKLIN ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2303
Country	:	US
Telephone Number	:	989-824-2374
Fax Number	:	989-546-8550

Provider Business Practice Location Address
First Line	:	207 N FRANKLIN ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-2303
Country	:	US
Telephone Number	:	989-824-2374
Fax Number	:	989-546-8550

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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