Provider Demographics
NPI:1982708673
Name:GIGUERE, CONNIE SUE (M A, MA P C)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:GIGUERE
Suffix:
Gender:F
Credentials:M A, MA P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16121 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9083
Mailing Address - Country:US
Mailing Address - Phone:810-714-2891
Mailing Address - Fax:
Practice Address - Street 1:2091 PROFESSIONAL DR
Practice Address - Street 2:SUITE I-1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3657
Practice Address - Country:US
Practice Address - Phone:810-732-1652
Practice Address - Fax:810-723-1735
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009658101YP2500X
MI68010190441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401009658OtherLLPC
MI6801019044OtherLMSW