Provider Demographics
NPI:1033792288
Name:SOUTHWORTH, ELIZABETH ASHLEE (BSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASHLEE
Last Name:SOUTHWORTH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 OLD SILO DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9637
Mailing Address - Country:US
Mailing Address - Phone:517-962-8127
Mailing Address - Fax:
Practice Address - Street 1:4980 OLD SILO DR
Practice Address - Street 2:
Practice Address - City:PLEASANT LAKE
Practice Address - State:MI
Practice Address - Zip Code:49272-9637
Practice Address - Country:US
Practice Address - Phone:517-962-8127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker