| Carolyn Waterstradt, Pllc | |
|
800 E Ellis Rd Norton Shores MI 49441-5646 | |
| (231) 799-4810 | |
| Not Available |
| Full Name | Carolyn Waterstradt, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 800 E Ellis Rd, Norton Shores, Michigan |
| Authorized Official Name and Position | Carolyn Waterstradt (THERAPIST/OWNER) |
| Authorized Official Contact | 2319038538 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn Waterstradt, Pllc 800 E Ellis Rd Norton Shores MI 49441-5646 Ph: (231) 799-4810 | Carolyn Waterstradt, Pllc 800 E Ellis Rd Norton Shores MI 49441-5646 Ph: (231) 799-4810 |
| NPI Number | 1922652783 |
|---|---|
| Provider Enumeration Date | 07/30/2019 |
| Last Update Date | 07/30/2019 |
| Medicare PECOS PAC ID | 2365771201 |
|---|---|
| Medicare Enrollment ID | O20190903000680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922652783 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Carolyn J Waterstradt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871996918 PECOS PAC ID: 7517272131 Enrollment ID: I20190514001072 |
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