MEDICARE: MS. COLETTE REN SPIRDIONE LLPC

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	247200000X	Other Technician		MI
2	101YP2500X	Professional Counselor	6401015183	MI

General Provider Information

NPI Number	:	1922453927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLETTE REN SPIRDIONE LLPC

Provider Business Mailing Address
First Line	:	2593 WILLOWBROOK DR
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9340
Country	:	US
Telephone Number	:	989-965-3417
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 N OGEMAW TRL
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9720
Country	:	US
Telephone Number	:	989-387-1767
Fax Number	:

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

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	07/31/2017

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