Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802066593 | MI |
NPI | 1003842725 |
---|---|
Provider Name | Lauren Jane Bal |
First Address | Kingsford, MI 49802-4456 |
Second Address | Kingsford, MI 49802-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LB066593 | BCBS OF MI (01) | MI |