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NPI Code Detail

MEDICARE: MARY JAMESON MSW

MEDICARE: MARY JAMESON MSW
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 Worker6801089518MI

General Provider Information

NPI Number : 1992106702
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JAMESON MSW
Provider Business Mailing Address
First Line : 400 JOHNSON ST
Second Line :
City : ALPENA
State : MI
Zip : 49707-1434
Country : US
Telephone Number : 989-356-2161
Fax Number : 989-354-5898
Provider Business Practice Location Address
First Line : 15774 STATE ST
Second Line :
City : HILLMAN
State : MI
Zip : 49746-7961
Country : US
Telephone Number : 989-742-4583
Fax Number : 989-742-2183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2014
Last Update Date : 07/24/2019

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