Provider Demographics
NPI:1295191435
Name:TIGHE, PATRICIA ANN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:TIGHE
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 1:408 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-3928
Mailing Address - Country:US
Mailing Address - Phone:206-450-5707
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-786-7212
Practice Address - Fax:906-786-0676
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010989931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical