Organization Name: | WEXFORD PHO |
NPI Number: | 1144679721 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIM SPEESE (EXECUTIVE DIRECTOR) |
Mailing Address: | 117 N Mitchell St Ste. 6 Cadillac |
State: | MI US |
Postal Code: | 496011884 |
Phone Number: | 2318767139 |
Fax Number: | 2317754187 |
NPI Enumeration Date: | 06/06/2016 |
NPI Last Update Date: | 06/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801086768 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |