1194850081 NPI number — DAWN MARIE STEFANSKI BS, LBSW, CAC R

Table of content: DAWN MARIE STEFANSKI BS, LBSW, CAC R (NPI 1194850081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194850081 NPI number — DAWN MARIE STEFANSKI BS, LBSW, CAC R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFANSKI
Provider First Name:
DAWN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, LBSW, CAC R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREVE
Provider Other First Name:
DAWN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194850081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 E KOTT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANISTEE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49660-9148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-723-1132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 E KOTT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANISTEE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49660-9148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-723-1132
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

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: 101YA0400X , with the licence number:  2-00446 (CAC II) , 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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