Provider Demographics
NPI:1588625222
Name:BEISCHER, ADELE MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ADELE
Middle Name:MARIE
Last Name:BEISCHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:
Other - Last Name:STOCKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:910 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079
Mailing Address - Country:US
Mailing Address - Phone:810-329-2041
Mailing Address - Fax:
Practice Address - Street 1:1322 N RIVER RD
Practice Address - Street 2:NORSERV GROUP LTD
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010610611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI740114Medicaid
MIN14450002Medicare PIN