Provider Demographics
NPI:1477643401
Name:MARTIN DUNN, JANE SCOTTIE (MSW LMSW)
Entity Type:Individual
Prefix:MS
First Name:JANE SCOTTIE
Middle Name:
Last Name:MARTIN DUNN
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:SCOTTIE
Other - Middle Name:
Other - Last Name:MARTIN DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1032 ALLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167
Mailing Address - Country:US
Mailing Address - Phone:248-349-0562
Mailing Address - Fax:
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 1490
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:248-423-2770
Practice Address - Fax:248-423-2783
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010077451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26384101Medicare ID - Type Unspecified