Doctor Name: | TAMMY GANNON |
NPI Number: | 1407298953 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6801090937 |
Business Practice Address: | 8183 High Point Trl White Lake, MI - 483863545 |
Business Phone Number: | 7348121397 |
Business Fax Number: | |
Mailing Address: | 8183 High Point Trl, WHITE LAKE |
State: | MI |
Postal Code: | 483863545 |
Phone Number: | 7348121397 |
Fax Number: | |
NPI Enumeration Date: | 07/25/2013 |
NPI Last Update Date: | 07/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801090937 |
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 |