1407228380 NPI number — MS. MARYANNE WOJDA MCLEOD MSW, LMSW, ACSW

Table of content: MS. MARYANNE WOJDA MCLEOD MSW, LMSW, ACSW (NPI 1407228380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407228380 NPI number — MS. MARYANNE WOJDA MCLEOD MSW, LMSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLEOD
Provider First Name:
MARYANNE
Provider Middle Name:
WOJDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LMSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOJDA-MCLEOD
Provider Other First Name:
MARYANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW,LMSW, ACSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1407228380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 MINNESOTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49837-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-280-8496
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 DELTA AVE
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
GLADSTONE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49837-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-280-8496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2015

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:  6801046359 , 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)





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