1083793897 NPI number — EMILIE BETHMAN HEINEMAN KUSCHINSKI LMSW

Table of content: EMILIE BETHMAN HEINEMAN KUSCHINSKI LMSW (NPI 1083793897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083793897 NPI number — EMILIE BETHMAN HEINEMAN KUSCHINSKI LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEINEMAN KUSCHINSKI
Provider First Name:
EMILIE
Provider Middle Name:
BETHMAN
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:
HEINEMAN
Provider Other First Name:
MITZI
Provider Other Middle Name:
EMILIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1083793897
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:
5090 STATE
Provider Second Line Business Mailing Address:
STE 103B
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-791-9712
Provider Business Mailing Address Fax Number:
989-791-8144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5090 STATE
Provider Second Line Business Practice Location Address:
STE 103B
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-791-9712
Provider Business Practice Location Address Fax Number:
989-791-8144
Provider Enumeration Date:
11/03/2006

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: 104100000X , with the licence number:  6801058757 , 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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