Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003585001 |
---|---|
Provider Name | Manon Lutzke |
First Address | Benzonia, MI 49616-9651 |
Second Address | Benzonia, MI 49616-9651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2021 |
Last Update Date | 13/09/2021 |