Basic Information
| Provider Information | |||||||||
| NPI: | 1033129879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAFT | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 376 E APPLE AVE | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494423466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317241111 | ||||||||
| FaxNumber: | 2317241300 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 E SOUTHERN AVE | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494425041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317243699 | ||||||||
| FaxNumber: | 2317243659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 12/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801064621 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.