Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801020851 | MI |
NPI | 1003234543 |
---|---|
Provider Name | Lisa Dengiz |
First Address | Ann Arbor, MI 48104-3529 |
Second Address | Ann Arbor, MI 48103-4910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 02/04/2014 |