Provider Demographics
NPI:1730289422
Name:STANTON, CORINNE E (MSW ACSW)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:E
Last Name:STANTON
Suffix:
Gender:F
Credentials:MSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0286
Mailing Address - Country:US
Mailing Address - Phone:517-449-7873
Mailing Address - Fax:
Practice Address - Street 1:790 E COLUMBIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1387
Practice Address - Country:US
Practice Address - Phone:517-449-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801068114104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1486Medicare PIN