Individual
ANDREW GARDNER-NORTHROP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
4401 CAMPUS RIDGE DR, MIDLAND, MI 48640-6112
(989) 837-9200
Mailing address
4000 WELLNESS DR PROVIDER ENROLLMENT CHRISTIE BUILDING, MIDLAND, MI 48670-0001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801096719
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801096719
STATE LICENSE
MI
Enumeration date
11/30/2017
Last updated
11/30/2017
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