1205975877 NPI number — MRS. INGRID ZOMBOREANU BOETTCHER MSW, LMSW

Table of content: MRS. INGRID ZOMBOREANU BOETTCHER MSW, LMSW (NPI 1205975877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205975877 NPI number — MRS. INGRID ZOMBOREANU BOETTCHER MSW, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOMBOREANU BOETTCHER
Provider First Name:
INGRID
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205975877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35742 UNION LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48045-3178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-469-6606
Provider Business Mailing Address Fax Number:
586-469-6364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21885 DUNHAM RD.
Provider Second Line Business Practice Location Address:
MCCMH - SRS STE 5
Provider Business Practice Location Address City Name:
CLINTON TWP.
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-469-6606
Provider Business Practice Location Address Fax Number:
586-469-6364
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801080115 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6801080115 . This is a "STATE OF MI, BOARD OF SW" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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