| Family Supportive Services Of Northern Michigan Llc | |
|
121 N Mitchell St Cadillac MI 49601-1879 | |
| (231) 878-8189 | |
| (517) 323-9531 |
| Full Name | Family Supportive Services Of Northern Michigan Llc |
|---|---|
| Speciality | Social Worker |
| Location | 121 N Mitchell St, Cadillac, Michigan |
| Authorized Official Name and Position | Jessica Deverman (OWNER) |
| Authorized Official Contact | 2318788189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Supportive Services Of Northern Michigan Llc 121 N Mitchell St Cadillac MI 49601-1879 Ph: (231) 878-8189 | Family Supportive Services Of Northern Michigan Llc 121 N Mitchell St Cadillac MI 49601-1879 Ph: (231) 878-8189 |
| NPI Number | 1164943353 |
|---|---|
| Provider Enumeration Date | 06/28/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 5092051144 |
|---|---|
| Medicare Enrollment ID | O20190109003415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164943353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801095051 (Michigan) | Primary |
| Provider Name | Chad M Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457461428 PECOS PAC ID: 8820022270 Enrollment ID: I20050924000086 |
| Provider Name | Jessica Deverman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659952836 PECOS PAC ID: 7315283322 Enrollment ID: I20220712000872 |
| Provider Name | Katie Ranes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386355733 PECOS PAC ID: 8729422399 Enrollment ID: I20240222001372 |
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