Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6801058356 | MI |
N | 1041C0700X | Clinical Social Worker | 6801058356 | MI |
N | 1041S0200X | School Social Worker | 6801058356 | MI |
NPI | 1003259557 |
---|---|
Provider Name | Mr. Crandall H Cranshaw |
First Address | Novi, MI 48377-2242 |
Second Address | Novi, MI 48377-2242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |