Basic Information
| Provider Information | |||||||||
| NPI: | 1427554328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | ESTER | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LLBSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STIRRETT | ||||||||
| OtherFirstName: | ESTER | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 132 MARQUETTE AVE | ||||||||
| Address2: | |||||||||
| City: | HOUGHTON LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486299223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895380672 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 655 E CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486242215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894269295 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2018 | ||||||||
| LastUpdateDate: | 04/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802089883 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.