Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801017214 | MI |
NPI | 1003023730 |
---|---|
Provider Name | Donna Andresen |
First Address | Kalamazoo, MI 49009-3016 |
Second Address | Kalamazoo, MI 49048-1640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |