Basic Information
| Provider Information | |||||||||
| NPI: | 1932440963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIETSCH | ||||||||
| FirstName: | BRITTANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W SPRING ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | MARQUETTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498554661 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489699932 | ||||||||
| FaxNumber: | 2489690840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2013 | ||||||||
| LastUpdateDate: | 08/21/2019 | ||||||||
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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 | 6801093960 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6801093960 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.