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NPI Code Detail

MEDICARE: MISS KRISTIN LYNN BLUE BA, MS, SST

MEDICARE: MISS KRISTIN LYNN BLUE BA, MS, SST
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 Worker6803085609MI

General Provider Information

NPI Number : 1861608143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KRISTIN LYNN BLUE BA, MS, SST
Provider Business Mailing Address
First Line : 24030 MEADOWBRIDGE DR
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48035-3007
Country : US
Telephone Number : 586-864-6118
Fax Number :
Provider Business Practice Location Address
First Line : 19401 NORTHLINE RD
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-2277
Country : US
Telephone Number : 734-785-7705
Fax Number : 734-287-8221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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