Provider Demographics
NPI:1184043309
Name:FRONTCZAK, DEVON (LMSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:FRONTCZAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:FRANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3675 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4147
Mailing Address - Country:US
Mailing Address - Phone:810-292-2391
Mailing Address - Fax:
Practice Address - Street 1:3675 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4147
Practice Address - Country:US
Practice Address - Phone:810-292-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011167051041C0700X
MI68511088611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical