Provider Demographics
NPI:1245674837
Name:SEGNITZ, JEFFREY RICHARD (BS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RICHARD
Last Name:SEGNITZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3364
Mailing Address - Country:US
Mailing Address - Phone:248-409-4163
Mailing Address - Fax:248-745-6872
Practice Address - Street 1:279 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3364
Practice Address - Country:US
Practice Address - Phone:248-409-4163
Practice Address - Fax:248-745-6872
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$OtherSOCIAL SECURITY NUMBER