Provider Demographics
NPI:1114072030
Name:GUERDET, MARY JANET (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANET
Last Name:GUERDET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730
Mailing Address - Country:US
Mailing Address - Phone:989-362-3961
Mailing Address - Fax:
Practice Address - Street 1:105 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-1305
Practice Address - Country:US
Practice Address - Phone:989-362-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C54500OtherBLUE CROSS