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Organization

ROOTS 45

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER ELLEN WUMMEL LMSW (BH THERAPIST)
(989) 350-3053
Entity
Organization

Contact information

Practice address
100 W 1ST ST, GAYLORD, MI 49735-1355
(989) 350-3053
Mailing address
2704 HICKORYWOOD DR, GAYLORD, MI 49735-6403
(989) 350-3053

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6801097139
MASTER'S SOCIAL WORKER LICENSE
MI
Enumeration date
12/21/2020
Last updated
12/21/2020
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