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Individual
MR. RANDY SIDEBOTTOM
Active
Individual
MR. RANDY SIDEBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MICHIGAN SOCIAL WORK
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802076484
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6802076484
STATE OF MICHIGAN SOCIAL WORKERS LICENSE
MI
Enumeration date
01/06/2015
Last updated
01/06/2015
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