Provider Demographics
NPI:1326483561
Name:WARE PETTY, DEBBIE (MSW)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:WARE PETTY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1375
Mailing Address - Street 2:108 11TH AVE WEST
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-1375
Mailing Address - Country:US
Mailing Address - Phone:405-650-1668
Mailing Address - Fax:
Practice Address - Street 1:108 11TH AVE W
Practice Address - Street 2:POB 1375
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-3243
Practice Address - Country:US
Practice Address - Phone:405-650-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker