1730456435 NPI number — COURTNEY SKEWES VANDE WIELE LMSW

Table of content: COURTNEY SKEWES VANDE WIELE LMSW (NPI 1730456435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730456435 NPI number — COURTNEY SKEWES VANDE WIELE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDE WIELE
Provider First Name:
COURTNEY
Provider Middle Name:
SKEWES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
SKEWES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730456435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 7TH AVE S
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ESCANABA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49829-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-233-1322
Provider Business Mailing Address Fax Number:
906-233-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 7TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ESCANABA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49829-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-233-1322
Provider Business Practice Location Address Fax Number:
906-233-1220
Provider Enumeration Date:
11/23/2011

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:  6801094388 , 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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