Provider Demographics
NPI:1679028161
Name:MANN, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MANN
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 1:306 MANZANA CT NW
Mailing Address - Street 2:APT 285-1D
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 MANZANA CT NW
Practice Address - Street 2:APT 285-1D
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-8445
Practice Address - Country:US
Practice Address - Phone:248-794-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker