| Travis Wolff, | |
|
1101 Military St, Port Huron, MI 48060-5418 | |
| (810) 984-5575 | |
| (810) 984-6433 |
| Full Name | Travis Wolff |
|---|---|
| Gender | Male |
| Speciality | Social Worker - Clinical |
| Location | 1101 Military St, Port Huron, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881078178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801098317 (Michigan) | Primary |
| Entity Name | St Clair County Community Mental Health Authority |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1689783672 PECOS PAC ID: 7416861984 Enrollment ID: O20031118000783 |
| Mailing Address | Practice Location Address |
|---|---|
| Travis Wolff, 1101 Military St, Port Huron, MI 48060-5418 Ph: (810) 984-5575 | Travis Wolff, 1101 Military St, Port Huron, MI 48060-5418 Ph: (810) 984-5575 |
Sara M Tavora, LMSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 520 Superior St, Port Huron, MI 48060 Phone: 810-984-4202 Fax: 810-984-8896 |
Heather Stewart, LMSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |
Callie Gunn, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |
Brian Fanion, LMSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |
Mr. Robert Marshall Ii, LMSW Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |
Kristen M Azzinaro, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |
Mrs. Deborah Louise Kokoszka, LMSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 |