Provider Demographics
NPI:1639571433
Name:DENNERT, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:DENNERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24574 COLIN KELLY
Mailing Address - Street 2:
Mailing Address - City:CENTERLINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1262
Mailing Address - Country:US
Mailing Address - Phone:248-277-6889
Mailing Address - Fax:
Practice Address - Street 1:24574 COLIN KELLY
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1722
Practice Address - Country:US
Practice Address - Phone:248-277-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker