Provider Demographics
NPI:1689279036
Name:MAWER, LINDA KAY-COLLINS
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAY-COLLINS
Last Name:MAWER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:KAY
Other - Last Name:LAFFERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6296 BRIDGEPORT VILLAGE
Mailing Address - Street 2:SQUARE DR SUITE 2
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722
Mailing Address - Country:US
Mailing Address - Phone:989-401-1239
Mailing Address - Fax:
Practice Address - Street 1:6296 BRIDGEPORT VILLAGE
Practice Address - Street 2:SQUARE DR SUITE 2
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722
Practice Address - Country:US
Practice Address - Phone:989-401-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician