Doctor Name: | MARY JO ANN WALENTOVIC |
NPI Number: | 1508149543 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6401012278 |
Business Practice Address: | 310 S Parker St Marine City, MI - 480393579 |
Business Phone Number: | 8108872805 |
Business Fax Number: | |
Mailing Address: | 310 S Parker St, P.o. Box 514 MARINE CITY |
State: | MI |
Postal Code: | 480393579 |
Phone Number: | 8108872805 |
Fax Number: | |
NPI Enumeration Date: | 09/26/2011 |
NPI Last Update Date: | 10/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401012278 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |