Provider Demographics
NPI:1235576208
Name:PIDEK, ANNE M (LBSW, QMRP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:M
Last Name:PIDEK
Suffix:
Gender:F
Credentials:LBSW, QMRP
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LLMSW
Mailing Address - Street 1:420 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2445
Mailing Address - Country:US
Mailing Address - Phone:810-240-3835
Mailing Address - Fax:810-257-3775
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-240-3835
Practice Address - Fax:810-257-3775
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851110381104100000X
MI6802086173104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker