Provider Demographics
NPI:1659495042
Name:WURDOCK, JON J (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:J
Last Name:WURDOCK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W WACKERLY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4703
Mailing Address - Country:US
Mailing Address - Phone:989-839-6565
Mailing Address - Fax:989-839-5794
Practice Address - Street 1:728 W WACKERLY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4703
Practice Address - Country:US
Practice Address - Phone:989-839-6565
Practice Address - Fax:989-839-5794
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010793631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical