Provider Demographics
NPI:1255300265
Name:MOODY-ULMER, MARGARET RAE (CSW-MSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:RAE
Last Name:MOODY-ULMER
Suffix:
Gender:F
Credentials:CSW-MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-2000
Mailing Address - Fax:
Practice Address - Street 1:4466 W BRISTOL RD
Practice Address - Street 2:MCLAREN NEUROLOGIC REHABILITATION INSTITUTE
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-342-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010625331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1019737OtherMCLAREN HEALTH PLAN
1019737OtherMCLAREN HEALTH ADVANTAGE
1356480685OtherMCLAREN LMSW GROUP NPI #
8008978470OtherBCBSM-BCN-FEP
056350OtherVALUE OPTIONS
MI0M41250013Medicare PIN
056350OtherVALUE OPTIONS