Provider Demographics
NPI:1083793897
Name:HEINEMAN KUSCHINSKI, EMILIE BETHMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:BETHMAN
Last Name:HEINEMAN KUSCHINSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:EMILIE
Other - Last Name:HEINEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:5090 STATE
Mailing Address - Street 2:STE 103B
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603
Mailing Address - Country:US
Mailing Address - Phone:989-791-9712
Mailing Address - Fax:989-791-8144
Practice Address - Street 1:5090 STATE
Practice Address - Street 2:STE 103B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603
Practice Address - Country:US
Practice Address - Phone:989-791-9712
Practice Address - Fax:989-791-8144
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON21430Medicare ID - Type Unspecified