Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 1041C0700X | Clinical Social Worker | 6801095196 | MI |
NPI | 1003158957 |
---|---|
Provider Name | Breeana Sobieski |
First Address | Auburn Hills, MI 48321-0550 |
Second Address | Novi, MI 48375-1320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 20/09/2018 |