| NPI | 1962553453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON WILLIAM MAGNUSON Director 906-228-5494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801070289) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2020-08-22 |