1336184753 NPI number — JANET WHEDON LMSW

Table of content: JANET WHEDON LMSW (NPI 1336184753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336184753 NPI number — JANET WHEDON LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEDON
Provider First Name:
JANET
Provider Middle Name:
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:
WHEDON-BLUMENFELD
Provider Other First Name:
JANET
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336184753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 PYLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49802-4456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-774-0522
Provider Business Mailing Address Fax Number:
906-774-1570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 PYLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49802-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-774-0522
Provider Business Practice Location Address Fax Number:
906-774-1570
Provider Enumeration Date:
06/19/2006

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: 1041C0700X , with the licence number:  6801058194 , 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: JW058194 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com