Provider Demographics
NPI:1376847202
Name:PATTEN, JOAN RENEE (BSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:RENEE
Last Name:PATTEN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5188 E VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9726
Mailing Address - Country:US
Mailing Address - Phone:989-793-4599
Mailing Address - Fax:
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-8570
Practice Address - Fax:989-777-8620
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086071104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker